Sunday, July 8, 2018

Is Your Pharmacist Banned From Helping You Save Money?

By Coleen Elkins, Managing General Agent

RV Insurance Benefits
24-7 Health Insurance 

Lawmakers on both sides of the isle are working to find ways to stop a practice which can keep customers from saving money at the pharmacy counter. "Gag clauses" buried in the fine print of pharmacy contracts, and imposed by pharmacy benefit managers prevent many pharmacists from telling consumers when the cash price for a medicine may be less expensive than their insurance co-pay unless the customer asks directly

Ending "gag clauses" is one option Republicans and Democrats are attempting to lower the skyrocketing cost of prescription drugs. President Trump singled out the clauses when he said he wanted to ban them in a May speech on drug prices. 

In the meantime as we wait for a government solution be a savvy consumer and ask at the pharmacy counter "Is this medication less expensive if I don't use my insurance". 

Friday, June 29, 2018

Back To The Future - Consumer Driven Health Plans

By: Coleen Elkins, Managing General Agent

24-7 Health Insurance 

RV Insurance Benefits

As we prepare for the Affordable Care Act tax penalty to be reduced to zero on January 1, 2019 we can anticipate changes once again as to how we insure our health.

I have a question for you to consider. Would you ever walk into a big box electronics store and give the clerk your Visa card and ask them to pick out a big screen TV for you?  I hope not! You compare brands, you look at brand ratings, you watch for the best sale price right?

Why then do we walk into our doctors office and blindly hand them our insurance card which provides us zero financial assistance until WE have spent over $5,000 on our deductible? Ponder this for a moment, if your health insurance premium is $900.00 a month you have spent $10,800 in a year for the privilege of carrying that health insurance card. If you utilized your insurance card and finally meet your $5k deductible and your $7,350.00 out of pocket maximum you now have spent $18,150.00 on your health that year.

Why are not savvy consumers when it comes to our health? Have we somehow we have been conditioned not to ask?

Twenty five years ago when we opened our first health insurance agency consumers were more proactive. Then along came health insurance copays provided by our friendly health insurance company, and for a very low monthly premium we now had unlimited office visits for a very low copay. The consumer lost the drive to be price conscious. Each year health insurance premium rose for over a decade.

In 2004 our government decided we needed to once again be proactive so they introduced Health Savings Account plans aka HSA's. We had a high deductible health plan, a low premium and a tax benefit. People once again began to become aware of cost and were saving money in a special savings account in the event they had to use their health plan.

Then in 2010 our Federal Government decided to get involved again and help consumers reduce the cost of their healthcare with the Affordable Care Act. They reduced the tax benefits of the HSA plans and in some cases they were not longer available to enroll in. Since 2010 insurance premium increased and networks narrowed from PPO plans to HMO plans to regional HMO plans causing many Americans to give up the doctor they had for years.

What will 2019 bring? Are the insurance companies standing by with solutions?

Actually a select few are and our agency already has solutions available in some areas of the country.

Consumer driven health plans are coming back. Referenced based pricing is on the rise to drive cost down and create competition.

We certainly are ready to help our clients find plans that fit their budget, give them their doctors back and provide options for cost savings by choosing where to receive care.

The state of Texas is a head of the curve. The Texas Department of Insurance recently created a website to the public called After entering their zip code a consumer can learn the cost of inpatient procedures, outpatient procedures, office visits, ER visits and more.

Here is an example of what you will learn when searching for cost of an office visit.

As a consumer driven health insurance agency we hope that the department of insurance in all states will introduce tools to drive down cost and raise consumer awareness.

Our focus is to be the advocate and a solution for our current clients we have had the privilege of serving for over 24 years, and to our new clients that seek our services which by the way are provided at no cost to you.

We look forward to being of service!

Thursday, January 25, 2018

A Peek Into 2018 Under Age 65 Health Insurance And Beyond

Alex Azar, Secretary Health and Human Services 
By Coleen Elkins

The Senate has approved the appointment of the new Secretary of Health and Human Services Secretary Alex Azar.

This morning we are seeing reports of more executive orders planned for 2018 to provide additional exemptions for those seeking relief from the mandate to purchase health insurance. 

The individual mandate was repealed in the new tax law recently passed, but requirements to purchase coverage doesn’t end until 2019. 

The new hardship or exemption list has yet to be revealed and we will post it if/when it becomes available. 

States are already beginning to look forward to new health insurance offerings. Concerned about soaring health care costs, Idaho on Wednesday revealed a plan that will allow insurance companies to sell affordable policies that ditch key provisions of the Affordable Care Act. Idaho is believed to the the first state to take formal steps without prior federal approval for creating policies that do not comply with the Obama-era health care law. 

Idaho Department of Insurance Director Dean Cameron said the move is necessary to make cheaper plans available to people. Cameron went on to say “There are other states that have been talking about it, but we may me out in front. They may look to follow us should we be successful”. 

The Idaho plan will make it possible for insurance companies to offer cheaper plans that might be more attractive to people who have to buy their own insurance and do not have the benefit from the federal premium subsides offered under the Affordable Care Act. 

Under Idaho’s guidelines, insurers can offer plans that deny coverage for pre-existing conditions for up to 12 months unless the customer had continuous prior coverage. Insurers would no longer be required to cover pediatric dental or vision care, and though they would have to offer at least one plan with maternity and newborn coverage, other plans could exclude those benefits.

Insurance carriers can also charge people more based on where they live, their health history and their age, under the new Idaho rules. Insurers can cap their own costs at $1 million a year per individual, and can charge customers separate out-of-pocket maximums for different services. In other words, a customer could have a $7,000 out-of-pocket annual maximum for prescription drugs, another for doctor visits and another for hospitalization or mental health care.
Insurers offering such plans in Idaho still would have to offer policies that comply with the federal health care law for those who want them, Cameron said.

There is speculation whether Idaho can legally move forward. The state expects objections from Obamacare Advocates. 

“I’m not even afraid if it needs to be litigated, though that’s not my preferred course,” Cameron said. “The real question is, when does the federal agency act — if they act at all.”

Saturday, October 28, 2017

2018 Under Age 65 Open Enrollment Begins On Wednesday November 1, 2017

By Coleen Elkins   24-7 Health Insurance 

Under age 65 health insurance open enrollment will begin on Wednesday November 1st 2017 and ends on December 15th 2017. This enrollment does not involve or require action for anyone on Medicare. 

The open enrollment period applies to anyone needing to change a current ACA compatible plan or who needs to enroll in an Affordable Care act compliant plan.

We encourage everyone to take the time to carefully shop and consider all their offerings for health insurance.  

We will be able to you provide you a personal needs analysis and proposals beginning on November 1st. 

Take advantage of our 23 years experience assisting our clients find the best health insurance plan that meets their personal needs. We keep our finger on the pulse of all thing legislative that will impact our clients decisions. We are licensed in 12 states to assist you. You can learn more on our website 

We promise our clients ongoing personal customer service once your policy is in place. 

We will only be presenting 2018 plans that are governed by the Department of Insurance in the state you purchase them. 

We will be offering the following options to insure your health for 2018:

  1. Affordable Care Act compliant plans outside of the exchange with private insurance companies. 

  1. Affordable Care Act compliant plans on exchange for those qualifying for a “tax credit” or a subsidy also known as premium payment assistance and possible cost sharing reductions. We will be able to determine your 2018 eligibility for a tax credit and enroll you. 

  1. Short term plans from multiple carriers in all 12 states we are licensed in that offer either a PPO or EPO nationwide network. 

  1. Small Group Plans for business owners with 2-50 employees. These plans are offered by A rated insurance carriers in all states we are licensed in. These plans have enrollment guidelines that vary by state.In some cases there can be a “group of one” enrollment.  
5.   Ancillary Plans such as dental, accident and hospital plans.                              

Some important things you should know about 2018: 

With the ACA compliant plans the rate increase of the Silver plans nationally for 2018 is 34 percent. 

Very Important: A study found In 47 of 50 cities in 2018, the cost of Obamacare's lowest-priced plan would be deemed "unaffordable" by the Affordable Care Act's own definition, according to a study from eHealth, Inc.

Under the Affordable Care Act, health insurance becomes unaffordable when the lowest-cost plan costs more than 8.16 percent of a household's gross income. Usually people who fall in this category can get an exemption from paying Obamacare's individual mandate. Your tax adviser will be able to assist you with an exemption which allows you to consider other options without a penalty. Please take 5 minutes to read the entire article here to help you understand the possibility of an exemption. 

A recent executive order signed by President Trump on October 12, 2017 allows health insurance companies to sell short term PPO/EPO plans for up to 360 days. Rather than in 90 day blocks imposed previously. Some carriers have already announced they will be implementing the enrollment changes. These plans offer a very affordable nationwide network. They do require some underwriting and do not cover pre-existing conditions. We have some very nice short term plan offerings for 2018. There are varying timelines on the offerings of these plans. 

We want our clients to be protected. If you have a grievance with your health insurance company we want you to have recourse. Therefore we are only offering plans governed by The Department of Insurance in the state you domicile. 

Plans we will not be offering for 2018:

  1. Shared Ministry Plans. Shared Ministry provide the consumer an exemption however they are not insurance plans and they are not governed by the Department Insurance which provides consumer protections. The Texas state legislature defines Shared Ministry Plans here: “Notwithstanding any other provision of this code, a health care sharing ministry that acts in accordance with this chapter is not considered to be engaging in the business of insurance”.

  1. Association Group Plans (group health insurance for 1 person). A recent executive order signed by President Trump on October 12, 2017 opened the door for the new forming of (Association Group Plans). The Department of Labor, CMS and other regulatory authorities were directed to look into regulating association plans allowing people to purchase across state lines. This will take several months to accomplish. The intent and goal is for existing “associations” to be able to provide members a viable health plan. For example purposes only…perhaps the American Diabetes Association could create a plan that insures diabetics or The Association of Realtors allowing Realtors to collectively purchase a nationwide plan. Even though you may see reference to this executive order know this has yet to take place and no new insurance company sponsored plans are being offered for this purpose. Understand the difference between an existing Association being able to pool together to purchase health insurance and an Association formed solely for the purposes of selling you health insurance! Association plans are not new they have been available since the 1980’s. Associations cropped up solely for the purpose of selling their members insurance at the highest possible profit and the lowest possible risk. They may look and feel like real health insurance. You will be asked to pay a “fee” to enroll. These plans are not direct with the insurance carrier. The plans are administered by a 3rd party which are leasing a major insurance carrier provider network. AGAIN the carrier is not administering or managing your claims. If you purchase an association plan from a state you do not domicile you may be putting yourself at risk. The reason is the only regulation of that plan is overseen by the state the plan originated in. History shows consumers have ZERO recourse with the state regulators and insurance commissioners in the states in which the plans were domiciled - because those state regulators and commissioners said it wasn't their job to regulate insurance sold to non-residents in another state. Until the Department of Labor and other Federal and State governing entities set guidelines and regulations for Association plans we will not be offering any type of Association Plan. 

Remember we purchase health insurance because we don’t know what the future holds. We encourage you to be cautious. Know your protections. If you are considering some innovative way to insure yourself do your research. Google the EXACT name of the plan (not the network) in multiple web browsers. REMEMBER: If you begin researching options and enter your name and phone number requesting more information you just gave marketing companies permission to call you. The only way you can stop the calls is to tell each individual caller to stop calling you and block their number. 

There are currently legislative hearings on solutions to the Affordable Care Act in both The House and the Senate. We are following them very closely and if anything significant arrises we will notify you immediately. 

We look forward to being of service.


Coleen Elkins,
Peace of Mind For Your Health Since 1995
Managing Agent
24-7 Health Insurance

Friday, October 13, 2017

Important News For The Under 65 Health Insurance Market

By Coleen Elkins    24-7 Health Insurance

On Thursday October 12, 2017 President Trump signed an Executive Order created to improve access, increase choices and lower the cost of healthcare. 

The Executive order provides directives to The Department of Labor, The Department of Treasury (IRS) and Health and Human Services. The Department of Labor’s secretary has been directed to consider proposing regulations or revising guidance to expand Association Health Plans (AHPs). The intent is to allow employers in the same line of business anywhere in the country to join together to offer healthcare benefits to their employees. This would be implemented to expand over time and lead to existing organizations and new ones created for the purpose of offering group health insurance. For example purposes only The Diabetes Association could work toward having a plan specifically to insure Diabetics. Associations with a common bond or purpose could choose to insure Association members to meet the needs of the members. State policy makers will have concerns that will need to be addressed as well. 

The secretaries of HHS, Treasury and Labor are to consider proposing regulations or revising guidance to expand short-term limited duration insurance. This directive would allow the agencies to revisit the rule enacted by the Obama Administration that limited the length short term plans could be purchased to three months. 

The Executive Order also opens the door to Health Reimbursement Arrangements for employer groups to assist their employees with the cost of healthcare expenses. 

The timeline is 60 days for the secretary of Labor to act within 60 days to consider proposing regulations or revising guidance on Association Plans. The Treasury, Labor and Has to act within 60 days to consider proposing regulation or revising guidance on short term plans and 120 days on Health Reimbursement Accounts. 

Within 180 days regulator agencies must report to the president on state and federal laws, regulations and policies that limit healthcare competition and choice, as well as on actions that federal and state governments could take to increase competition and choice and reduce consolidation in healthcare markets. 

On an action separate from the Executive Order the White House Confirmed Thursday that it will stop making federal payments for “cost-sharing reduction” payments to health insurers. These cost sharing reductions reduced the out of pocket costs for health care for those in certain income brackets by lowering deductibles and out of pocket expenses for them. A statement from Department of Health and Human Services confirmed the “cutoff would be immediate”. 

We have spoken to insurance companies and are told they are acting now to make changes to their systems to provide revised health insurance products and longer purchase durations ready for 2018. 

Coleen Elkins

24-7 Health Insurance 

Wednesday, September 27, 2017

No Vote - No Repeal of Obamacare

By Coleen Elkins   24-7 Health Insurance

No Vote - No Repeal of Obamacare 

On September 26th 2017 Senator McConnell declined to hold a vote on the Graham-Cassidy bill which would repeal and replace parts of The Affordable Care Act. The bill did not have the support needed to pass under reconciliation rules which expire on September 30th 2017. 

What is next? 

Prior to the vote a Senate formed committee HELP (Health, Education, labor and Pensions) held bipartisan hearings to discuss “actions Congress should take to stabilize and strengthen the under 65 health insurance market” for 2018. It is possible the bipartisan committee could resume efforts to achieve their goal. 

The Republican leadership can also begin the reconciliation process over again for 2018 fiscal year. Starting the process over would require a 2018 budget resolution with the appropriate instructions for reconciliation to pass both chambers of the House and Senate. Then 2018 bills would be drafted and voted on in both chambers. An identical bill must bass both chambers before President Trump can sign it into law.

Alternatively Congress or the Administration may pursue other ways to dismantle, replace or reform the ACA including regulatory action, non-enforcement or other options. 

In the meantime ACA Remains the Law of the Land

Ongoing compliance with the ACA is required unless and until official guidance to the contrary is issued. 

2018 brings new challenges particularly for employer groups with the implementation of the Cadillac tax, HRA, HSA and FSA funding parameters and more. 

We recommend individuals purchasing their own plans without a tax credit use the website exemption tool to determine if they may qualify for an exemption from Obamacare for 2017. The exemption could avoid penalties for those that qualify. The 2018 tool will not be available until next year. Your tax advisor may be able to help you file the proper exemption form at tax time. 

Insurance companies have until the end of the day today (September 27)  to report their intention to stay in the market for 2018 and if they are going to insure what they will be filing for 2018 rates. Florida already has projected a 45 percent rate increase of this years rates in 2018 for under age 65 health insurance plans. 

Open enrollment for 2018 is drastically shortened to November 1, 2017 to December 15, 2017

Friday, September 1, 2017

Will Obamacare Really Fail? 

We are carefully following all writing regarding the future of health insurance in America.

Senator Bernie Sanders is touring the country rallying for Medicare for all. It is very doubtful Medicare for all would pass any CBO analysis.

Today we would like to share with you one of the most comprehensive articles we have received from our business partner AHCP Sales. 

By now, everyone’s heard the news: the Republican efforts to repeal and replace the Affordable Care Act have failed in the Senate. After three unsuccessful votes—first on the Better Care Reconciliation Act, then on a repeal and delay bill, then on a skinny repeal—majority leader Mitch McConnell declared on July 27 that “it’s time to move on.” For now, repeal & replace is dead, though the efforts could certainly be revived sometime in the future.

While there is much disappointment among Republicans and their supporters at this apparent failure, members of both parties are now saying that they need to work together on a bipartisan solution. Of course, time will tell whether this can really happen, but many lawmakers are saying that they’re willing to give it a try. In fact, as USA Today reports, a bipartisan Senate panel will be holding hearings on September 6th and 7th on stabilizing the individual insurance market.

Meanwhile, President Trump is calling for his party to continue with the repeal efforts; after all, he says, Republicans have promised voters for the past seven years that they have a much better plan, so they shouldn’t give up so easily. His criticism of Majority leader Mitch McConnell has also increased in the past few weeks, leading to a rift that some worry will derail the GOP’s other legislative priorities.
Please continue reading here