Roger Bayer, Compass Ins. Advisors

09/30/2024

For my friends who are 65 or older: The Annual Enrollment Period (AEP) for Medicare begins Tuesday and ends December 7. Will your next year plan be the best for you? If you want help determining the best option, call me.@ 240-349-2545. Tell me you are a friend. I will help you with the options no matter if I can take an application or not.

06/02/2024

What does a health insurance broker do?

The first responsibility is to help the client select the best health plan that meets the client’s needs. Needs usually are budget, practitioners, prescriptions and hospitals that the client wants covered by the plan.

For Medicare clients, first discuss the differences between a Medicare Advantage plan and a Medigap plan. Help the client decide which is best. A note of caution, many health insurance brokers are not authorized to provide Medicare Advantage plans. It is worthwhile confirming that the agent you are talking to is certified for Medicare Advantage (all agents can sell Medigap plans). So, to understand all of the options, you really need to talk to a broker authorized to sell both Medicare Advantage and Medigap plans.

For under age 65 clients (U65), set up a marketplace account. In Maryland, Pennsylvania and Washington DC, this is done through their state exchange. In other states, this is done through Healthsherpa.com, which is a friendlier user interface to Healthcare.gov.

There is no marketplace for Medicare plans. The broker works directly with the insurance carriers.

When the plan is selected and the application is complete, enter the client's order. If the system requests verification of one or more aspects of the application get the verification documentation from the client and upload it. Usually the verification requested is for income or citizenship status.

Generally, no other actions are required until the fourth quarter of the year. If problems arise, serve as the client's ombudsman with the marketplace and/or the insurance company.

All plans end on December 31. If the client does nothing, the plan is either renewed by the Marketplace (U65) or the insurance carrier (Medicare) to the current plan or if that plan no longer exists, rolls the client to a new plan which the marketplace feels is the closest equivalent plan. The renewed plan can have different terms and conditions.

All of this occurs from October to December for Medicare and November to January of the following year for clients under the age of 65. Every year for every client your broker should review the health plan the marketplace selected. If it is still the best plan for the client's needs, let it roll over. If there are one or more better plans available in the new year, the broker should let the client know and help them switch plans, if they wish.

04/03/2024

There are three different types of insurance agents, independent, call center and company dedicated. Which you use can impact the cost and service you receive. With all three types you deal with an agent. The agent for each type of insurance are compensated differently:

Company dedicated (captive) agents work for the company that they represent or are committed on selling a company’s products. Allstate or State Farm agents are examples. These agents can and usually give good service, but the products they offer are limited.

Call center agents respond only your inquiries. They can sell both ACA (on exchange) plans and non-ACA plans. The plans that they can sell are limited to those that the call center approves. The call center provides inbound leads at no charge to the agent. When the agent sells a plan the agent receives a one time commission. The agent is motivated to sell as many plans as possible in a period of time.

The independent broker generally can represent the broadest range of companies. This helps finding the best plan at the best price. For each person on an ACA plan that remains active, the agent receives a small monthly commission, around $20. The commission is fixed at this amount no matter what the client pays for the plan. The commission for off exchange plans can be higher. The objective of the independent broker is to keep clients happy to keep the flow of monthly payments. The client never pays a commission. They are paid by the insurance companies.

I should note that I have worked both as a call center agent, then currently as an independent agent.

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03/19/2024

Most things we buy have a single price. Health insurance pricing consists of a total of three different prices: co-pay/cost sharing, the premium and the deductible.

Co-pay/cost sharing are charges for specific services when you receive the service. Co-pays are a fixed dollar amount, e.g. $20 or $40. Cost sharing is the percentage of the charge you are responsible for. The amounts vary by service and what your plan specifies. Medicare supplemental plans F & G do not have these costs.

Premiums are the fixed amount you pay every month for your plan. All plans have premiums. Some or all of the premium for Affordable Care Act plans are paid by the marketplace. Insurance companies that offer Medicare Advantage plans receive a supplement from the marketplace, so a $0 premium is not unusual.

The deductible is the amount the client has to pay out of pocket before the plan pays benefits. The deductible can range from $0 to over $7,000. In general, the higher the deductible, the lower the premium. Many ignore the impact of the deductible. Here is an example: one plan has a $0 premium and a $1,000 deductible. The other plan has a $50 premium and a $0 deductible, which plan costs less? If you assume you have $1,000 in expenses in a year, the $50 a month premium costs less than the $0 a month because when you divide the deductible by 12, it works out to about $83 a month.

Of course, there is a lot more to the subject, which I will explore through these posts. If you have any questions, send them to [email protected] or call me: 240-349-2545.

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03/08/2024

Back to the blind men and the elephant analogy, the debate on using a Medigap plan or Advantage Plan is one of the best examples. Both are good, what is best for you depends on certain factors.

Most of the people that I work with that have a Medigap plan are well off enough to not mind spending several hundred dollars a month for health insurance. A Medigap plan, particularly a plan G, is very straightforward and easy to understand. You pay a serious premium which allows you to go to any medical service provider that accepts Medicare. There are no networks and no referrals required. A plan G covers all services 100%.

There are many Medicare Advantage plans that have a $0 premium. Some services, such as visiting a primary care doctor, are covered 100%. Most services have a co-pay. Depending on the type of advantage plan you have, you may have to use the insurance company’s network of service providers.

To sell an advantage plan, an agent has to complete a roughly five hour course and take a 50 question test annually. Then for every advantage company an agent represents, A two hour course and 20 question test must be completed. To sell a Medigap plan only requires a state insurance license. The net result is that there are a lot more agents selling Medigap plans only and they tend to raise concerns about aspects of advantage plans.

Deciding on an insurance plan is very much a financial decision. If you rarely use medical services that require co-pays and your doctors are in network why sign up for a large premium? If you do have a need to visit specialists regularly, a Medigap plan might be more cost effective.

Of course there is a lot more to the subject, which I will explore through these posts. If you have any questions, send them to [email protected] or call me: 240-349-2545.

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03/07/2024

So far most of my posts have been about insurance for those whose age is under 65. I probably should have started by discussing Medicare. The federal government, CMS, runs traditional Medicare. Medicare Part A for hospitalization and Part B for medical services are the components of traditional Medicare.

CMS discovered that running an insurance company is tough, so when prescription drug coverage was made available, Medicare Part D, the decision was made to have insurance companies run the various plans. The government, CMS, provides funding and regulates the insurance companies, but does not directly work with the client.

Traditional Medicare covers about 80% of medical service cost. The way medical services are priced makes the remaining 20% a very high number. Medicare supplemental (Medigap) plans were developed by the insurance companies, under CMS guidelines to cover some or all of the 20%.

So at this point, the client is paying a premium for Medicare, Medicare Part D and a medigap plan. At the same time, CMS is struggling to run traditional Medicare. CMS, using the same approach as they used for Part D drug plans, established Medicare Part C (Medicare Advantage). Medicare Advantage plans cover everything traditional Parts A, B and D cover plus usually add dental, vision and other services not covered by traditional Medicare. CMS funds the insurance companies but does not run any plans.

So there are two paths to complete coverage, a traditional plan with medigap or an advantage plan. Depending on the needs of the client, one approach will be better than the other. Future posts will discuss this. Can’t wait? Send an email to [email protected] or call me 240-349-2545.

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03/04/2024

My last post implied that if your age is under 65 and your employer does not offer group insurance you have to purchase a health plan through the ACA exchange assuming you have minimal income. You are not forced to use an ACA plan, but there are two important aspects that are why most people use an ACA plan. Depending on your gross annual income, the ACA pays part of or even all of the premium. Just as important, all ACA plans are guaranteed issue.

Guaranteed issue means that there are no health questions and pre-existing conditions are ignored. Pretty much all the off exchange (none ACA) plans have health questions and the premium for the plans and the issuance of the plan can be based on your answer to the health questions.

So why use an off exchange plan? If your income is too high for any kind of tax assistance, an off exchange plan can be a better option. You need to be careful to confirm that the plan you pick covers your health risks.

Have questions? Send them to [email protected] or call me.

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03/01/2024

Most Major Medical plans for individuals under the age of 65 are provided either through group insurance or through the Affordable Care Act (ACA) marketplace. The ACA marketplace subsidizes some to all of the plan premium with an income tax credit and provides the subsidy over 12 months. If your gross income is too low to use a tax credit, you will get no subsidy and the health plan will be too expensive. Individuals with very low income have to look to Medicaid or community health plans for medical services.

For the majority of folks, the ACA marketplace subsidizes premium cost based on gross household income, family size, family ages and the home address zip code. If the gross income is too high, there is no subsidy.

All of the plans available through the ACA marketplace are from private insurance companies. The ACA marketplace is an exchange that lists the availability of plans. The ACA marketplace regulates the companies and the companies plans that are allowed to be listed on the exchange. The ACA marketplace, unlike Medicare, does not provide government plans.

Want to see all of the plans available in your zip code? Go to rogerbayer.com, scroll to the bottom of the first page and use the link for under age 65.

03/01/2024

The purpose of health insurance is to reduce the financial costs of using medical services. Health insurance plans can be considered either multi risk or specific risk plans. Major medical plans are multi -risk, The Centers for Medicare and Medicaid Services (CMS) states that a major medical plan has to provide ten essential services. Here is the address of a good description of these services: https://www.verywellhealth.com/what-is-covered-under-obamacare-4083032.

These posts divide health insurance into major medical and ancillary (which is everything not major medical) plans. Major medical plans are delivered to individuals through severeal different paths: Group plans are provided through an employer. For individuals who are younger than 65 (U65), plans are sold by insurance companies through the Affordable Care Act exchange or directly from a company (not through the exchange). For individuals aged 65 and over, basic Medicare is provided by CMS. Many enhancements and extensions to basic Medicare are provided by the insurance companies.

Ancillary insurance plans do not provide all of the ten essential medical services. Generally, they target specific medical risks, like dental, cancer, critical illness, accident, hospitalization, etc. There is a group of insurance plans, generally called “short term” plans that cover some, but not all of the essential services.

Future posts will delve into the above in greater detail.

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02/28/2024

Yesterday I used the analogy of five blind men describing an elephant to characterize most folks understanding of health insurance. The intent of these facebook posts is to feed up an understanding of the elephant a bite at a time. If you want a more complete picture right now, please go to my website, rogerbayer.com.

The opening page of the website is mostly about me. Across the top of the page are a series of tabs, that when clicked, provide information on various aspects of health insurance. Like these facebook posts, no specific insurance company or plan is discussed. What is discussed are the benefits and features of different types of insurance.

Want to talk about specific insurance offerings? Call me 240-349-2545 or send a note to [email protected].

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02/27/2024

The intent of this page is to provide health insurance education. It is not to sell health insurance. No insurance companies or specific plans will be presented. Selecting a company and a plan has to be based on your personal needs. Call me, 240-349-2545 if you have a plan related question.

If you are never sick and know that you will never be sick, you don’t need health insurance. If you are not that lucky, the purpose of health insurance is to reduce the cost of being sick. You have to balance the cost of a plan with the benefits provided by the plan. To do this with confidence, you have to understand health insurance..

Everybody thinks they understand health insurance, but it is more like the story of five different blind men describing an elephant. Most folks understanding is based on their personal experience. The intent of these posts is to present the entire elephant.

Do you have questions and want answers now? Either call me at the number above or send a note to [email protected]