Gilmore Insurance Services

08/28/2019

I was listening to the radio while driving today and the oddest commercial came on. It was about if the democrats win, everyone will lose their prescriptions as government will take over the drug industry and will refuse to let people get the drugs they need...… They were focused on Medicare people and were trying to scare them into voting a certain way. Don't let the government take over your Medicare.

First Medicare is run by the government as well as the formulary in the plans. The government sets the guidelines and insurance companies who want that market comply. I am about to do my Medicare recertification this week as it is required every year. Government oversight is passed onto the insurance companies to manage agents and make sure no one is harmed in the process. The odd thing was the voice on the radio was telling people to be afraid of those who make sure they aren't harmed.

It was about drugs and the cost. The hard thing is while drugs are going through the roof, the prospect of capping drug companies profits creates a catch 22

New drugs are introduced to the American market 3-5 years before they go to the world because of profit restrictions. The problem becomes do drug companies still work to create new drugs if the profit is locked in?

Are we at a point in time where we have enough medicines to do us? Is there still an incentive to produce new drugs if the profit is locked? Are we good with what we have?

I would rather see copyright protection changed back to how it was intended. 7 years then generic, unless significant improvement in the drug gives another 7 years. Right now it seems many drugs have an extended copyright life that keeps the costs unnaturally high.

While not pretending to have all the answers, please keep this in mind.... if they are trying to scare you or on the other hand promising too much, be wary.

05/22/2019

As we move forward as a country, it is likely that we will move towards a single payer system. The question is how do we get there? All at once? or do we work it in?

The hard part is all we are seeing is these huge Trillion dollar amounts, how do we break those down to what will it cost me? or my kids? Should my kids be charged the same, less or nothing at all? A trillion or trillions means nothing if it can't be broken down into real household numbers.

This is far from an easy task. Healthcare in what ever form from insurance to the janitor at the clinic is roughly 20% of what is produced in this country. Do we nationalize this 20% and make them government workers? Do we leave some sections private? Most people involved in healthcare are more likely to be your neighbor, rather than some really rich person. Their incomes are going to be close to yours.

They also will be the first cuts in the system as those who've made a great deal will be the last effected. When we look at insurance we will find that most people are still involved with claims, and claims processing will not go away no matter single or multiple player. Medical didn't become such a large portion of our economy by silly things. There may not be tons to trim off as some think.

I will post more later. This is better broken up into chunks

Thanks.

07/23/2018

It's been a while since I posted and health care is still in the news.

I have started to see what may come this fall and it bothers me a bit. I am starting to see group plans offering a really low cost with one catch. The catch is you have to fill out a medical questionnaire. What concerns me and this was how it was before is people will see a super low rate... and then the questions come...

The more "yes" answers even for the simplest conditions, start boosting the premium. Sort of a bait and switch. I have quoted these plans before and they drive me nuts. Why? because you never know the final rates until it's almost too late to go elsewhere.

I have had quotes from these set ups show 15% below everybody else and then after medically underwriting come back 20% higher. The rate jump wasn't because of cancers, or serious conditions.. the rates jumped because thyroid medications, HBP meds and a pregnancy.

We were able to go back to the plan that started out 20% higher, but ended up 15% cheaper....

WA state has committed to not leaving people to have to "qualify" for their insurance. We've been a guarantee issue state since 1994, long before other states did the same. I hope that continues as while not cheap it is better for consumers in WA.

03/22/2018

An interesting opinion piece in the local paper about dentists and dental insurance today. The dentist group was complaining about the largest carrier not giving them what they wanted. They felt that a law should be created that requires 92 cents on the dollar be paid out from dental insurance plans. For comparison, the ACA (Obamacare) requires 80 cents on the dollar to be paid in claims. I don't see how the overhead for a dental insurance company is that much less than a medical insurer. There isn't a magic community where everything is cheaper, from electricity to employees..

The company they are complaining about is the most popular employer plan in our state. There is a reason for this. They do provide fair benefits and process claims quickly. But the thing they have done, which we don't think about, is provide rate stability. They have managed to keep their rates stable or apply slight increases during a time where medical rates skyrocketed.

They have done this by reducing payouts to dentists and to people like myself who present their plans to business around the state. They do this because they realize they aren't as important to an employer as medical insurance is. They can't have rate increases like medical.. Why? because they are in line behind medical. They are not on equal footing and know it. So they tighten the belt as tight as it can go.

Do I like it? Yes and no. Nobody likes making less money, but as long as they are keeping their rates stable or increases down to pennies. I can live with it, because they are not getting rich at my expense and they are insuring that when I sit down with a business, the renewal will be easy to do and everybody remains happy. Employees get good dental coverage and continue to see their dentists on a regular basis.

10/07/2017

Sad day today. I am in the beginning point of renewals for group healthcare plans with existing clients. A very busy time. A very uncertain time as well. But that's not what this post is about.

While going over paperwork for a group for their renewal, I reviewed a phone message from earlier today when I was out of the office. A short message that someone found my card and asked for a call back. No details.

Called back and spoke to the woman. She had found my card in her husband's desk. He passed three weeks ago. She had no idea what or if he had coverage or what it was, she was just calling to see if he had insured himself through me. He had. She had no idea what insurance he had or with whom. She just found my card. I am starting a death claim for her.

What this thread is about is a reminder. Insurance companies don't know when somebody passes. They have to be told.
I have always given several cards to the people I insure with instructions to give someone else the card with my contact information on it. So somebody besides the insured knows who to contact. This is a little thing that some remember to do, but most don't.

Please consider this a reminder to share the contact information with someone, so the agent or the insurance company can be contacted to start the process. Everything will get taken care of, imagine if she didn't find the card?

06/29/2017

Just a second to try and explain what is going on with healthcare right now. The ACA was not failing, the legs were being cut out from under it to try and make it fail.

Two things Obama promised the insurance industry were the mandate and covering loses to stay in certain markets. These were the carrots provided to the industry to make them participate. The mandate reduced cherry picking health insurance and only using it when sick and helped spread the risk even farther to help with pricing.

The covering of loses in certain markets was done to "keep" insurers in markets where they were losing money. Normal business concepts tells us if we're losing money someplace, we leave that place. The ACA in order to keep all markets open promised to at least let insurance companies break even so they wouldn't need to pull out. And so they stayed, until that money became threatened by the new administration that it would be paid at all. So with 2018 in question, insurance carriers either had to plan those losing markets loses into their premiums for 2018 or do like Regence just did and simply stop selling individual plans in 2018. The other option was simply not to sell in counties that were loss counties. So for a while two WA counties had no insurance for 2018.

The people cheering this on fail to understand that if a carrier pulls out of sales in an area, dropping the ACA doesn't bring them back to the area. They are pulling out because they lose money in that area (county or state) and the ACA was the only means of helping them break even to provide coverage. Take away that means? Do they return to losing markets? NOPE.

I will post a bit more later about other aspects in what's going on. One thing we have to start looking at the coverage provided rather than whose name is on the plan. Most people in WA liked their insurance before the ACA (Obamacare) came along. But you should see the chins hit the floor when you explain to them that in WA state we were under the Clinton plan since 1994.

That created a problem for some because they really hate the woman, but love the plan she created for them. I lobbied hard back in the 90's to block the Clinton plan and honestly it was horrible the first few years, but fixes made it work and work well for WA residents. Maybe that's the approach with the ACA we should adopt. Let's fix the bugs and stop calling it Obamacare. Then maybe some people will like it as much as they liked Hillarycare, when they didn't know it was her ideas in action.

05/24/2017

Quick follow up on yesterday's story about the pharmacy error. I spoke with the person today and she had a refund of $600 plus after contacting the pharmacy. Seems the person who helped her, was working her very first day. :)

I am so glad she called and asked the question rather than just accept the bill. So many things can make a health plan seem bad that really don't have anything to do with the health plan.

The lesson from this story, is review your bills. If something doesn't seem right ASK. The worst that can happen is the cost is confirmed. The best is what was written up a paragraph or two above. The pharmacy would have never known it over charged without the question being asked. This was not something that would have been caught and corrected on it's own.

05/23/2017

Bits and Pieces:
As we near midway through 2017, still no word on 2018 from the government. Companies are expected to file their 2018 rates in the next two months. No word from DC as to a new health plan will be created or if the current administration will back the payments they are supposed to for the ACA to support areas where insurers took loses.

Please take the time to check any bill or prescription you've had filled. Just had a call today where someone paid $700 plus for prescriptions. The conversation started out with what a crappy insurance plan... As we went through the billing, so many things seemed wrong. Lots of pennies for each RX. That caught my eye because usually copays are dollars without cents. Like $5, $30, $50. The only possibility of cents on the bill would be for specialty drugs where there is a percentage rather than a copay. These were generic medications, no specialty.

As we walked back through the visit to a rather large box store, the pharmacist did not take the medical card, even though the person had never been there before. The receipt had the notation "cash plan" on it. No mention of the insurance coverage or savings. It ended up with the person calling back and the bill is being refigured to the copays rather than the cash basis. Should get her about $600 back from the store.

The point is, always review your explanation of benefits and receipts you get to see if they match what your plan states. There are a lot of hands involved with the distribution of health care and sometimes mistakes are made. In the above case the number was so large that the insured called and we were able to figure it out and fix it. Mistakes happen with so many involved, if it doesn't seem right, call and ask.

03/30/2017

Well we still really don't know with certainty what health insurance we will have in 2018. Will it be Obamacare or something else? I really am not sure, but I know insurance companies rate filings are due in a couple months for 2018 so if we make it to June, assume the ACA will still be the plan used in 2018.

Not much thought was given to the idea that it takes a while to change things over. Insurance companies have to file rates with their respective states office of the insurance commissioner about 6 months ahead of time as the OIC can contest rates and challenge rate increases. There actually is a rate formula that has to be filed with the state. Insurance companies have to prove that any rate increase is justified. Believe it or not......

So if there isn't something happening politically in the next couple months expect the ACA to be there in 2018.

12/17/2016

Healthcare in 2017
Originally, I was going to make this memo for one of my group clients, but thinking about how 2017 is going to just about everybody who has health insurance, I thought I will just make this note.

2017 is going to be the year of the Network changes. Just about every plan is going through a network overhaul. What you had in 2016 may not be there in 2017 because a doctor or a hospital will no longer
be in a plan’s provider network.

While that used to be not such a big deal, some plans are no longer providing coverage for elective “out of network” visits. Those visits won’t count in 2017 towards your health care insurance costs and won’t
be picked up at say 50% as they were in the past. So if you choose to go out of your network for elective services, they may not be covered.

EMERGENCIES ARE COVERED at least in the United States. The most often cited concern to me is about “what if it’s an emergency? ” You can be served in the case of an emergency even at a hospital not in your network and have coverage. I would suggest you read your insurers definition of “what is considered an emergency?” in your plan booklet. It will be there in the definition section.

Please note, some plans will not provide emergency coverage for travel abroad.

The best way to protect yourself from unexpected costs is to check before you go. Your insurance card has an 800 number that you can call and ask before you visit. Better to spend 5 minutes on a call than $500 out of pocket for not checking before you go.

Please keep in mind this is occurring across all the insurance carriers. Since health plans are currently set in stone for features and maximum costs, the only place that can be tinkered with is networks. And for 2017 a lot of tinkering has taken place.

As far as what the future of health insurance is going to be, it’s hard to determine yet. I have read immediate repeal, but not taking effect for 3 years (?). Other things are being said that have me scratching my head.

All I know is Insurance Companies need time to make any changes that may be coming. So whatever happens, it will take some time. Please remember to check before you go, don’t wait till the bill arrives to find out your coverage.

Thanks,
Larry
Gilmore Insurance Services
800-745-7033
www.gilmoreins.com
[email protected]

Insurance and mutual fund broker for individual and company group benefits in Washington state. Retirement plans for group and individuals. Health and other benefit coverages for group and individuals.