GOA Signs Up 11 Fictitious People For Heathcare

By Coleen Elkins


A Government Accountability Officer Report states GOA officials successfully enrolled eleven fictions people up for the health exchange. This was done by using fake immigration and income documents, and they were able to obtain subsidies for these people that do not exist.


Republican Senators are pressing the new HHS Secretary to take action in response to the report. The Center For Medicare and Medicaid Services is aware there are problems with the system. They have admitted that a million people may be at risk of paying back a portion of their subsidies because there were not eligible for them.

The administrations response is they are catching up to fix problems that plagued the system early on.


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Blue Cross Of Louisiana Blames Affordable Care Act For Rate Increases

By Coleen Elkins

State insurance carriers are in the process of announcing rates for 2015. It appears the normal increase is going to be double digit amounts, but how much will consumers be expected to pay next year? Health and Human Services says they expect enrollment to double under the Affordable Care Act from 2014 to 2015. This new enrollment is expected to bring on "healthier people".  They project this will lower premiums in the future.

Each states insurance department will review the proposed rate increases to make sure increases are inline with expected claims.

Blue Cross and Blue Shield of Louisiana services primarily individual enrollees rather than those insured through employee benefits. Three of the four Louisiana Insurance companies will be asking to increase rates by double digits on certain plans.

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Insurer Bailout - Taxpayers Could Be On The Hook For $725 Million In 2014

 By Coleen Elkins

Is there light at the end of the tunnel for health insurers? Some insurance carriers became fearful when they began to realize their premiums may have to rise as high as 20 percent in 2015.

The Affordable Care Act created a risk corridor to protect the insurance companies that take on the sickest patients. Keep in mind risk corridors protect profits not patients. The intent of the program was to pool payments from insurers and redistribute the funding to the companies that enrolled the chronically ill and the higher cost patients. This would pass the bill off the the companies with higher profits.

The administration has eased the minds of insurance carriers by issuing rules that permit taxpayer funding to be paid out through the "risk corridor program" which was supposed to balance itself.

Premiums are still rising by double digits in some states and the laws reinsurance and risk corridor are set to expire in 2016. What consumers see for rate in 2017 may be shocking as a result.


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Annual Health Insurance Rebates Will Be Paid Out Soon

By Coleen Elkins

Under the Affordable Care Insurance carriers can only keep a certain amount for profit. This results in reconciling their profits and rebating to the consumer if they are over the allowable amount.

Nationally the rebates will average $49 totaling  $332,000,000.00 for 6.8 million insured. Not all will receive a rebate check and amounts will vary. It will be determined by reconciliation of each carriers premiums received and claims paid out. The rebates occur when an insurance carrier fails to spend 80 percent of premiums received on medical care. Each year it is projected the rebate checks will get smaller and fewer will be receiving them.

Anger Over Narrow Networks Under Obamacare Is Growing

By Coleen Elkins

Is you doctor going to be there for you under your new healthcare plan? Consumers are learning they have new network restrictions that they were not told about when enrolling in their new plan and they are very upset. Some patients in rural areas are having to drive great distances to see a primary care doctor or specialist. So how do insurance carriers keep cost down and still provide access?

Insurers have been directed under the affordable care act to include enough doctors and hospitals to provide timely access to care. Even though the directive has been issued there are now specific guidelines for the insurers to operate under. Some states are working to raise their standards. More than 70 bills have been introduces in 22 states to clarify network rules.

There is another big question not addressed in this article. What if the doctors do not want to participate in the new networks under the affordable care act? What if the law has reduced their pay or does not guarantee payment if an insured skips out on their premiums after the new "90 day grace period"?


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A Pilot Study Will Exempt Some Seniors From Medicare's 3 Day Rule

By Coleen Elkins

There is a Medicare rule that a beneficiary must spend 3 days in the hospital prior to being admitted to a nursing home. This rule has left many seniors with denied claims and large out of pocket costs. If a hospital does not admit a person but holds them for observation the clock does not start ticking on the 3 days. Seniors are very frustrated by this.

For example if someone is held for observation for 24 hours and then admitted for 48 hours they have only spent two days in the hospital. If they are transferred to a nursing home the after the 2 day stay that nursing home stay will not be covered by Medicare.

The number of observations patients ineligible for Medicare-covered nursing home care has shot up by eighty eight percent in the last 6 years to 1.8 million in 2012.

Only Congress can change this rule. As always we encourage you to contact your local Legislatures
regarding changes to laws that are important or may impact you.

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Preparation Begins For Nevada To Connect To The Federal Health Insurance Marketplace

By Coleen Elkins

The state of Nevada had a rocky start with their state health insurance exchange for 2014. This has triggered some major changes for 2015. Xerox the contractor responsible for facilitating the state exchange was fired in May.

An audit preformed by Deloitte (an accounting firm) recommended Nevada tie it's Medicaid software into the federal system. Nevada accepted the recommendation and hired Deloitte to complete the task.

In order to do this Nevada amended their existing $28 million dollar contract with Deloitte which is the 9th amendment to the contract. The amendment adds a 16 million dollar payout to Deloitte. The contract was issued without competitive bidding for the services. Even though competitive bidding saves tax payers money the reason for not seeking bids was "there was not enough time". A hand full of blue chip companies have been awarded contracts in 17 other states.

Oregon, Minnesota and Maryland are three other states that have hired Deloitte for more than $63 million combined. Deloitte certainly has grown in the health insurance industry. Hopefully the money spent will iron out the wrinkles and make 2015 easier on consumers seeking to enroll.

Colon Cancer Survivors Challenge Medicare Loophole

By Coleen Elkins


Having a colonoscopy as part of a wellness exam can save your life. Most colonoscopies are preformed every 10 years and at shorter intervals for those at risk. Often in the course of the procedure polyps are found and removed.

For Medicare beneficiaries the "no cost" wellness exam just became a surgical procedure and in no longer considered wellness. Many patients are surprised when an unexpected  billing statement arrives in the mailbox.

Some colon cancer survivors feel there should be no cost for the polyp removal.  Reason being removal of those polyps can prevent the patient from getting colon cancer. Prevention and early detection by biopsy of the polyp can save lives and as a result save Medicare money in treatment of the disease.

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Survey Shows 89% Of Seniors Say They Are Optimistic About The Future

By Coleen Elkins


Despite some financial uncertainty todays aging population are feeling positive about their future. The reasons vary and at the top of the list is friends and family. The second reason is their living situation followed by being well prepared financially and being in good health. A phone survey polled 2000 adults half of whom are over the age of 60.

The USA Today article goes on to say that Baby Boomers have a lot going for them. They are in better health, better educated and more active.

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Should You Be Monitoring Your Blood Pressure At Home?

By Coleen Elkins

Blood pressure is the pressure of the blood in your arteries as it is pumped around your body by your heart. Hypertension or high blood pressure usually does not have symptoms. It can however lead to serious health issues. High blood pressure is a known factor in developing cardiovascular disease.

Measuring your blood pressure at home is easy and relatively inexpensive as a reliable machine can be purchased at drug store and other retail outlets. It is best to be relaxed an sitting when taking your blood pressure. Blood pressure is recorded in two numbers such as 120/80. The larger number (systolic pressure)indicates to pressure in the arteries as the heart pumps out blood during each beat. The lower number (diastolic pressure) indicates the pressure as the heart relaxes before the next beat.

Studies are finding those that monitor their blood pressure at home can reduce their healthcare costs and it is also saving insurance companies money in paid out claims. This is raising the question should home monitors be covered by health insurance for those at risk?

Inspector General Reports Medicare Made $1.7 Billion In Suspect Payments

By Coleen Elkins

A recent report by the Inspector General indicates that Medicare made suspect payments to more than 1,000 laboratories in California and Florida in 2010.

The total amount of the payout was $1.7 billion dollars. Medicare was suspucious of the claims as the came from ineligible physicians but they paid the claims anyway. In many cases the claims where filed for patients residing more than 150 miles away from the prescribing doctor.

Labs represent less that 2 percent of Medicare spending.

The investigation will be looking into whether anti-kickback laws have been violated.

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California Policy Holders Sue Anthem Over Narrowing Networks

By Coleen Elkins

Anthem Blue Cross of CA has been sued by policy holders for narrowing networks under Obamacare. This is the second suit in California in less than a month by insureds.

Policy holders were moved by Anthem from their existing non-compliant plans to a new plan that meets the mandates of the law. In the process they have lost their doctors. Additionally state regulators are investigating whether Anthem provided members with inaccurate provider lists. Both Anthem and Blue Shield cut available providers on marketplace plans to reduce premium rates.

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Poll Finds Many Insurance Brokers Consider Leaving Their Career After ACA

By Coleen Elkins

BUT NOT US!


There is no doubt health insurance brokers jobs have become more difficult. What used to take an hour or so can now take 3 hours or longer. It can also involve return trips to see a client because of unforseen obstacles in achieving the goal of getting them insured.

After years of working in an industry we have awaken in a new world which is at times confusing and literally dysfunctional. The newly required certifications do not prepare us for the obstacles we face in helping a client obtain health insurance.

If the process is uncharted for us I can imagine how a consumer feels. Even if they are "tech savvy" that does not make them "insurance savvy". Often they find that what they thought they bought they did not receive. Those seeking subsidies don't understand the qualification and income requirement process. Even after the enrollment is complete further documentation may be required, and if they don't respond their coverage will be cancelled by the government.

All of this makes me even more determined to stay the course. People need someone who listens because they care. They need someone who can point them in the right direction and give them guidance so they can make an informed decision. Consumers want and need confidence that when they walk into a doctors office their insurance card is going to be accepted and their claim paid.

We are here to help our clients understand and maximize their benefits! We are staying the course!

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Supplemental Insurance Provides An Extra Layer Of Coverage

By Coleen Elkins

Having health insurance is a good thing but, it often leaves you with large out of pocket costs should you have an accident or a catastrophic illness. Most policies today have deductibles ranging from $3600 to $6300 per year.

Some health providers are requiring deductibles be met at the time services are rendered unless it is a medical emergency. If you don't have the cash on hand you may be left scrambling to come up with the cash to continue diagnostics or treatment.

Supplemental Insurance may be the protection most need to cover the shortfalls. These plans provide cash in the event of an accident or critical illness. The cash can help with covering your deductible or just paying the household bills.

These policies typical have a small monthly premium cost and can offer peace of mind.
A health insurance agent or broker can share your supplemental options with you.

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Thousand Of Florida Seniors Caught Off Guard

By Coleen Elkins

Thousands of Florida Seniors were caught by surprise when CMS (Centers for Medicaid and Medicare Services) changed their Medicare.

Their Medicare Advantage Plan Physicians United was declared insolvent and they were returned to original Medicare without notification back to June 1st 2014. This has resulted in large out of pocket costs for many insured. The Florida based insurer served 38,000 members in 17 counties.

Seniors have been given until August 31st to select a new Medicare Advantage plan.

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