The purpose of Obamacare was a great idea for two reasons:
– Health coverage
– Avoiding a tax penalty

Circumnavigating Circumstances for Insurance

However, as of 2019, the penalty for going without insurance has been removed, bringing many Americans to ask, “Why should health insurance be a priority?” With differing financial circumstances around the nation, it is often difficult to decipher the confusion health insurance brings to the table.

Quite simply put, health insurance is a benefit to you and your family’s lives as an investment in the unknowns of your futures. Even if you are a primarily-healthy adult, unforeseeable circumstances could leave you paying exorbitant amounts of money if you do not have reliable health insurance. For example:

– The average price of repairing a broken leg is $2,500
– A simple doctor’s visit without health insurance can cost anywhere from $300 to $700

Choosing A Better Future

With health insurance, these fees can be drastically reduced. A doctor’s visit can cost you a small copay, and that alone can bring peace of mind. Research has recently shown that almost 44% of Americans stay home because the cost of care is too high, and they were uninsured. Seeking out Michael Suhany Insurance is a reliable, trustworthy way to counter you from joining such a startling statistic.

Finding Results that Work For You

Insurance agents such as Michael Suhany can assist you in navigating the confusing decisions for questions such as:

– What is a “short term health plan” and should I enroll in one?
– How can the changes of insurance in 2020 benefit me and my family?

Michael can also help you wade through the possibilities of acquiring Private Medicare Advantage (MA). MA insurance plans are specifically targeted towards a client’s need to stay within a specific budget; a benefit other insurance plans do not provide.

Pursuing health insurance doesn’t need to be a headache. But even if you don’t see the immediate need for it, Michael Suhany can answer the questions which have kept you from being confident as you move forward with your future.

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Even if your health has stayed well-balanced through the last year, revisiting Medicare’s policies may help you choose a better plan for your current life stage.

When is Open Enrollment?

The enrollment window is October 15th through December 7th, and changes made to your plan take effect on January 1st, 2020. What is open enrollment, you may ask? Open enrollment is the season where Medicare providers allow you to make changes to which policy you are enrolled in.

What Questions Should I Ask About Medicare Open Enrollment 2020?

One of the biggest mistakes medicare beneficiaries make is forgetting to review their policy during this window, and then being shocked by differing fees or a possible switch in providers. For example, if you are enrolled in Medicare Part B, the base amount for 2020 may increase to $144.30 from its amount of $135.50 this year. If you don’t take the time to review those changes, you may find yourself strapped with medicare fees you can’t afford, or missing out on a better plan which actually attends to your current medical needs.

It may be the case that in this season’s open enrollment you find yourself needing assistance with primarily paying for medications. If that is the case, it may be wise for you to switch to a Medicare Part D plan. It would be wise to understand that, when enrolling in Medicare Part D, this plan does not cover every prescription, but often has alternative drug plans for you to consider which allow you to take advantage of its coverage.

Do I have other Options?

Depending on where life takes you, Medicare Supplemental Insurance –or “Medigap”— may pique your interest. This is the only Medicare plan that covers any medical care you may encounter out of the country. The only detail many beneficiaries of Part D don’t initially realize is, in order to partake in Part D and its benefits, you must also have Part A and Part B to qualify.

The Medicare Open Enrollment season is still accessible for 2020. Contact your local Kosciusko insurance agent, Michael Suhany, to get your questions answered before time runs out.

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If you’re reading this, chances are you have a health insurance plan either through your parents, your job, or individually. Even if you’re covered right now, you may find yourself in a position where you’re having to pick a new insurance plan. Whether you’re turning 26 and being kicked off your parents’ plan, you just accepted a new job with insurance through a different company, or you’re needing insurance on an individual basis after retiring or becoming self-employed, the time will come and you should be prepared. If you or a family member has ongoing health needs, you need to be sure that these are covered before choosing your new health insurance plan.

What Is A Pre-Existing Condition?

A pre-existing condition is defined as an ailment or injury that exists before you enroll in an insurance plan. These conditions vary from acne to cancer to everything in between. Even some insurance companies still consider pregnancy a pre-existing condition. It wasn’t until the Affordable Care Act was passed in 2010 that pregnant women and their unborn children had to be covered by insurance even if you become pregnant after your plan starts.

Here are just a few conditions that would need to be disclosed before your insurance plan starts in order to be covered:

• Acne
• Arthritis
• Asthma
• Carpal Tunnel Syndrome
• Crohn’s Disease
• Depression
• Diabetes
• Eczema
• Glaucoma
• Hypertension
• Varicose Veins
• … and even more

The Affordable Care Act Protects You And/Or Your Family

The Affordable Care Act also prevents your insurance company from charging you more or denying you coverage because you have pre-existing conditions. This rule applies to insurance plans beginning on or after January 1, 2014. This new rule, however, does not apply to “grandfathered” insurance plans that went into effect on or before March 23, 2010.

It’s Important To Remember Your Mental Health When Choosing Your Health Insurance Plan

Mental health should be prioritized right now, especially in the midst of COVID-19. Your mental health can be covered as a pre-existing condition if you are diagnosed before you begin your new insurance plan. Even with insurance, mental health treatments can be expensive so be sure to discuss your benefits with your insurance provider. You can also read this article for more information regarding mental health and health insurance.

As the pandemic’s long-term effects on the health of affected Americans continue to be debated and researched, the implications may lead to widespread adoption of including COVID-19 on the list of pre-existing condition members very soon.

Right now, though, it appears health insurers would rather create an exclusion for it either retrospectively back to about a year or exclude it outright for someone who unknowingly was infected by it and didn’t “seek the proper medical care or treatment” during that period.

Let Me Help You Pick The Right Health Insurance Plan For You And/Or Your Loved Ones!

The Michael Suhany Health Insurance Team is here to help you receive the best coverage for your specific needs. No one should ever pay more because they have a health issue or injury. You should never need to worry about if you or a loved one will be covered if treatments are needed.

Please reach out to me and let’s discuss you and your family’s needs. I would love to help you! Get your free quote today or call me at 574-306-2028.

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The Role of Agents and Brokers

The study reports “Among all those who got help with enrollment, the most frequently-reported source of assistance was health insurance brokers or agents (15 percent, including 34 percent of those who switched plans), followed by navigators and other enrollment assistance programs (8 percent), family members or friends (7 percent), and health plan representatives (6 percent).”  What this means is that insurance agents and brokers were far and away the most desired source of help to enroll in a Marketplace or non-Marketplace Qualified Health Plan.  Further, when individuals who had coverage in the previous year went to actively change their policy, even a higher percentage sought out the assistance of an agent or broker as opposed to other forms of assistance.  In fact, the percentages of those seeking all other forms of assistance for actively changing their policies went down. This indicates that the more experience consumers had with the Marketplace the more they valued and trusted the help of agent and brokers.

The Partisan Divide

The survey reports on the actual experience of those enrolled in individual plans under the ACA in great detail.  What was the greatest predictor of the overall opinion of enrollees toward the Affordable Care Act?  Was it their actual experience with their specific health plan?  No, “Even among this population – whose views one might expect to be divided more on the basis of experience – the biggest differences in opinion are along partisan lines, with 75 percent of Democrats having a favorable view of the law, 79 percent of Republicans expressing an unfavorable view, and independents divided (40 percent favorable, 44 percent unfavorable).”  Is it time to consider if partisanship is playing too great a role and actual experience too small a role in our considerations about the type of healthcare we will have in this country?

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Marco Rubio’s Healthcare Reform Proposals

Marco Rubio states that his healthcare reform proposal will “Expand access to affordable, quality health coverage by providing every American with an advanceable, refundable tax credit that can be used to purchase insurance.”  Such a proposal recognizes that everyone having health insurance is a social good, but that people can sometimes lack motivation to obtain or be unable to afford coverage.  This proposal attempts to use the tax code to address this problem.  Presumably, someone who refuses to obtain coverage would forfeit their tax credit and would thus be motivated to purchase insurance.  The tax credit would also make coverage affordable for those who could not otherwise be able to pay for coverage.

Further, Marco Rubio states that his plan will “Reduce health care costs, promote innovation, and ensure access for the most vulnerable by expanding access to consumer-centered health plans, reforming insurance regulations, and putting protections in place to ensure those with pre-existing health conditions can get access to affordable coverage.”  This proposal covers quite a bit of territory.  The most significant element concerns those with pre-existing health conditions and the desire to ensure that those who have these conditions can get affordable health insurance.  This requires that insurance companies accept these people who are at higher risk of incurring claims and that they spread this risk out to healthy people in the form of increased premiums.

Third, Marco Rubio says that his plan will “Promote innovation in the Medicaid program by giving states a per-capita block grant, which preserves funding for Medicaid’s unique populations while freeing states from Washington mandates.”  This proposal recognizes that being on Medicaid can be a miserable experience of bureaucrats making eligibility determinations, administrators making coverage decisions, and difficulty in finding providers who will take Medicaid’s diminished reimbursements.

Barack Obama’s Healthcare Reform Accomplishments

How do the proposals that Marco Rubio has made compare with the current state of healthcare under the Affordable Care Act?  One of the central features of the Affordable Care Act is an “advanceable, refundable tax credit that can be used to purchase insurance” called the Advanced Premium Tax Credit.  This tax credit is administered through the Health Insurance Marketplace.  The Affordable Care Act also provides for Cost Sharing Subsidies that further lowers Out-of-Pocket Costs for lower-income individuals and families.  The Affordable Care Act is doing just what Marcio Rubio proposes and it does more to make health insurance and healthcare costs affordable.

Marco Rubio wants healthcare reform that protects people with pre-existing conditions so they can purchase affordable coverage.  This is precisely what the Affordable Care Act did in phases, beginning in 2010 and completely beginning on January 1, 2014.  The Affordable Care Act does this by requiring insurance companies to take people without medical underwriting and without charging them a higher premium because of their medical condition.  The Affordable Care Act is already doing just what Marcio Rubio is proposing.

Finally, Marco Rubio wants the states to run Medicaid so that innovation free from Washington mandates can prevail.  Well, he needs to come to Indiana and talk with Governor Pence about the Healthy Indiana Plan like I have because this is exactly what the Pence and Obama Administrations were able to accomplish under the Affordable Care Act.  The public officials in the State of Indiana who had the experience of an innovative program to provide healthcare to those with lower incomes worked with federal officials to implement that program as an expansion of Medicaid much to the benefit of lower-income Hoosiers.

Conclusion

Maybe the next President and Congress will repeal the Affordable Care Act.  If Marco Rubio becomes President, he will be trying to replace it with something that looks quite similar.

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Donald Trump has released his healthcare reform plan on his campaign web site.  He calls on Congress to make seven specific changes in the laws that he will presumably sign if he is elected the next President.  What are the proposals?  What do they really mean for the marketplace and the consumer?  Will his healthcare reform plan work?

1. Completely Repeal Obamacare Including the Individual Mandate

Donald Trump calls for the repeal of Obamacare in general and specifically the Individual Mandate.  The Individual Mandate is the requirement under the Affordable Care Act that almost everyone must either demonstrate that they have health insurance or face a penalty when they file their taxes.  The Individual Mandate is certainly one of the least popular features of the Affordable Care Act, but what else would happen if the Individual Mandate went away?

If the Affordable Care Act were to be repealed and the Individual Mandate as well, the insurance market would have to return to much the same state it was before the implementation of the law.  Insurance companies would once again ask medical questions of their applicants.  People could be denied coverage or charged higher premiums because of their medical conditions.  Pre-existing conditions could be excluded.  Affordability would once again be a major concern as insurance premiums would be no lower than 2013 levels and the tax credits under the Affordable Care Act would go away.

If most of the Affordable Care Act were to remain intact but the Individual Mandate were to be removed, then insurance companies would be faced with leaving the market altogether for inability to stay solvent or further increase premiums to make up for the fact that healthy people formerly purchasing insurance and paying premiums would no longer keep their policies.

2. Modify Existing Law that Inhibits the Sale of Insurance Across State Lines

Donald Trump wants laws modified that interfere with selling insurance across multiple states.  The theory that gives rise to this suggestion is that state regulation of insurance interferes with competition in the marketplace resulting in fewer choices for the consumer and higher prices.  If insurance companies do not have to deal with each state department of insurance, the belief is that there will be greater competition, more choices, and lower premiums.

There are two problems with this specific proposal by Donald Trump.  The first is that the laws that regulate the sale of insurance within a state are state laws.  Congress and the President can’t rewrite state laws.  If he is proposing federal law that overrides state regulation, then he is proposing a system that will either lack the consumer protections that the states have enacted or an even bigger federal role in health insurance than even the Affordable Care Act represents.

The second problem with this specific proposal is that it is contradictory.  The proposal states “As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state.”  Do we want state regulation or not?  And how is this second part of the proposal any different from the current state of affairs where the states set requirements and any company who wishes to comply can compete in the state?

3. Allow individuals to fully deduct health insurance premium payments from their tax returns.

Donald Trump wants individual health insurance premiums to be a tax deduction just like group health insurance premiums are for employers.  Under the current tax code, employees who receive their health insurance through an employer are receiving a tax advantage that is not available to employees who have to purchase their own health insurance.  Under a group health plan, the employee contribution can be made with dollars that are not taxed.  The employer contribution is not taxable income to the employee and it is a business expense to the employer.  Making individual health insurance premiums a tax deduction would level that playing field.  The only negative would be the loss of tax revenue to the government.

4. Allow individuals to use Health Savings Accounts (HSAs).

Donald Trump wants to encourage the use of Health Savings Accounts.  Health Savings Accounts have been around for years and are a valuable tool in helping people make the best use of their healthcare dollars.  For most people, it makes sense to purchase a less expensive policy where office visits and prescriptions are paid by the policy owner and credited toward the policy deductible.  The policy owner can then open up a tax-favored savings account that allows them to pay their out-of-pocket expenses with dollars on which they do not have to pay income tax.  The only new wrinkle that this proposal seems to add is that the accounts would not be subject to inheritance tax which would benefit very few people.

5. Require price transparency from all healthcare providers

Donald Trump wants doctors, clinics, and hospitals to disclose their pricing.  This is presumably to allow people to price shop for their medical care.  The first question is just how much of a person’s healthcare are they either willing or able to access based on price.  If someone needs to schedule a lab test or some diagnostic imaging that they will pay for out of pocket, it is certainly possible to imagine calling multiple providers for prices.  If someone is ill and needs to see a physician, are they price-shopping for the cost of an office visit or are they trying to get an appointment with their primary care physician?  If you need open-heart surgery, are you price-shopping to save the insurance company money or are you trying to find the most skilled surgeon possible?

The second question is why a physician’s or hospital’s pricing should be any more public than the provider chooses to make them.  Shouldn’t a provider be free to negotiate pricing as they choose?  Shouldn’t a provider be free to negotiate a better price and keep their reimbursements private from an insurance company that brings them a high volume of patients and pays promptly in preference over another insurance company with fewer patients to offer and slow reimbursements?

6. Block-grant Medicaid to the states.

Donald Trump wants states to manage Medicaid to provide better care and to reduce fraud, waste, and abuse.  The states already do manage Medicaid with most of the money coming from the federal government.

7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

Donald Trump wants American consumers to have “access to imported, safe and dependable drugs from overseas.”  The first question is who it is that will determine whether the drugs from another country are safe and reliable.  Does this proposal mean that drugs from other countries still have to meet the standards of the Food and Drug Administration?  Does a drug just have to be approved for use in some country somewhere for it to be legal to import into the United States?

The second question has to do with how it is that a drug from another country is less expensive than a drug in the United States.  Certainly, a pharmaceutical company in another country may simply have a competitive advantage over a U.S. company and be able to produce the medicine for less.  What about cases where the government in another country is subsidizing the drug maker and creating an unfair advantage for the U.S. company?

Conclusion

Is this the type of plan for Healthcare Reform that will make America great again?  I’ll let the reader draw their own conclusion.  I do hope that I have provided some helpful perspective on these proposals.  Let me know if you have any questions.

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