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Does Medicare cover cancer treatment? When this first came up I thought, what a silly question. Of course it does.

Then I discovered people who have cancer policies, many they have had for years, and continuing to pay for them after they turned 65 and enrolled in Medicare.

No doubt many cancer insurance policies are sold, and bought, based on fear. My personal feeling about cancer policies have changed over the years. At one time I felt they were a waste of money. That position is tempered a bit. I still don't think most people NEED a cancer plan but if you want one for ancillary coverage, go for it.

Surprisingly, the biggest health issue for retirees on Medicare is not cancer but Arthritis.  Cancer ranks number three behind arthritis and heart disease.

Does Medicare Cover My Cancer Treatment?

Does Medicare cover my cancer screening and treatment? How about chemotherapy? How much will I have to pay for my cancer treatment? Does Medicare cover the rest? 

From a purely financial perspective, most people with original Medicare and a supplement (Medigap) plan will not have to worry about how they will pay for the cost of cancer treatment. Most Medigap plans cover 100% of your hospital inpatient (Medicare Part A) expenses and the bulk of your outpatient care.

Original Medicare pays all of your hospital inpatient bills and 80% of your outpatient medical expenses. Your Medicare Part A hospital inpatient deductible is $1288 in 2016 and your Part B (outpatient) deductible is $166.

Most Medigap plans cover your Part A deductible. Medicare supplement plans F, G and N pay the remaining 20% of approved Part B claims.

Cancer fighting drugs may be covered under Medicare Part B or Part D.

I have clients that are currently being treated for cancer. Their out of pocket costs for chemotherapy is $0 in most cases thanks to original Medicare and a solid Medigap plan.

Georgia Cancer Resources

How can I get help paying my medical bills? How much does it cost to treat cancer?

Beyond the thought of dealing with your illness, financial concerns can cause as much stress as the disease. Fortunately there are resources and support groups.

This site has a list of cancer resources you may find helpful. You may also want to search additional information about cancer by following this cancer information link.

#DoesMedicareCoverCancer #CancerResources #CancerTreatment

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A doctor that doesn't take Medicare? Get out of here! No way. All doctors accept Medicare.

Don't they?

Most do, a few don't.

If you are turning 65 and enrolling in Medicare, there are things you need to know.

Medicare Assignment, No Assignment, Opt-out

Roughly 99% of doctors participate in Medicare and 96% of those accept Medicare assignment. That makes your job a lot easier.

If you have original Medicare.

Not so much if you have a Medicare Advantage plan.

With original Medicare you can use (almost) any doctor anywhere in the United States. No networks. No referrals. No paperwork.

Your job is a bit more complicated with an Advantage plan.

Advantage plans run on a calendar year basis. "Your" doc may participate this year but not next year. That can make it a challenge if you have a medical condition that needs the attention of someone who really knows your history.

And what about that 1% of doctors that opt-out of Medicare.

Opt-out doctors who accept no Medicare reimbursement and put the onus on the patient to foot the entire bill, except for medical emergencies. These physicians are required to tell patients the costs of services up front and have them sign what are known as private contracts, agreeing to the opt-out method. - Next Avenue

Doctors that opt-out of Medicare is generally limited to the psychiatric field. If you need counseling, are turning 65 and enrolling in Medicare you need to ask your therapist if they participate in Medicare

What if Your Doctor Says No?

Don't be too concerned. Remember, most doctors participate in Medicare but some are not taking on new patients.

In 2010 a Texas Medical Association survey found that 18 percent of the state's physicians were restricting the number of Medicare patients they treated, while 16 percent were no longer seeing new Medicare patients. 

Nationally, the number of physicians who still participate in Medicare is unclear. As of 2008 only 58 percent of physicians were willing to see all new Medicare patients, while fully 13.7 percent were no longer willing to see any new Medicare patients, a survey by the Center for Studying Health System Change survey found.4 Both a 2010 American Medical Association (AMA) survey and the 2011 National Ambulatory Medical Care Survey found that about 17 percent of physicians were restricting the number of Medicare patients they treat. - National Center

I am a baby boomer enrolled in Medicare. Moreover, I have over 400 clients in Georgia, all have original Medicare. 

Most had doctors before turning 65, and every one of them were able to keep their doctors. The few that did not have a doctor before 65 had no trouble finding someone to accept them as a new patient.

A few clients moved to Georgia from other states. A few had a serious ongoing medical condition.

One lady was recovering from ovarian cancer but had a relapse shortly after moving here. She had no trouble getting accepted into an Emory Hospital practice that specializes in her type of cancer.

Not only was she able to get the care she needs, but all of her inpatient and outpatient bills have been paid by Medicare and her supplement plan. Her only out of pocket for medical care is the Medicare Part B deductible ($166 in 2016).

Another client had not seen a doctor in years but had been, in his words, "feeling puny" for several months. He was looking forward to turning 65 and getting on Medicare.

Almost immediately after enrolling in Medicare he made an appointment with a doctor for his Welcome to Medicare physical. He had been taking antacid medication for several months for heartburn.

After several tests he was diagnosed with esophageal cancer. Living in south Georgia, was a challenge since there were few doctors nearby that could effectively treat his condition. 

The good news is he was accepted into a specialized treatment program at Mayo Clinic in Jacksonville. His condition has improved considerably thanks to the aggressive treatment at Mayo.

Once again, his only out of pocket for medical treatment has been the Medicare Part B deductible. All of his hospital bills and all of his outpatient medical bills that exceed the Part B deductible are paid in full.

Tomorrow we will address the question, "Does Medicare Cover Cancer Treatment?".

#DoctorsNotTakingMedicare

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In the movie Animal House a young actor (Kevin Bacon) played the part of Delta House pledge Chip Diller. As part of the initiation ritual, pledges had to subject themselves to humiliation by assuming the position and being whacked in the butt with a paddle. 

Most of the main characters in Obamacare either decided not to pledge or have flunked out.

While most of the carriers have lost money by the buckets, a few have thrived in the Obamacare market and are coming back for more.

Centene has learned how to make money in the Medicaid market. A combination of lean plans and even leaner networks seems to be a winning combination when serving up health insurance on the dollar menu. That same approach works well in the Obamacare market.

At the same time, carriers like United Health Care, Assurant, Humana and others were losing money by offering prime rib to the bologna crowd.

You can count Health Net in the loser bunch.

Then along comes Centene who gobbles up the Arizona and California business written by Health Net. That move created financial indigestion for the otherwise profitable Centene.

Centene's ACA exchange profits remain “at the high end of our targeted range,” but acquiring Health Net dragged the company down 

Specifically, the losses were tied to “unfavorable performance” in Health Net's Arizona and California individual markets. That included a lack of risk-corridor funding and detrimental effects from the “grandmothering” of older, pre-ACA plans, which means they only had to comply with some of the ACA's standards. Health Net also has PPO plans with broader networks of hospitals and doctors, which often appeal to sicker people who are willing to pay higher premiums if it means their providers are in-network. Conversely, Centene offers more high-deductible, narrow-network plans with cheaper premiums, plans that attract price-sensitive consumers. - Modern Healthcare

But not to worry. Centene will correct the problems caused by the stupidity of Health Net when 2017 rolls around.

Come 2017, Health Net won't be playing in the Obamacare market while Centene will only offer plans in a few markets. Residents can say goodbye to rich plans with broad networks. They will be replaced by a much leaner fare.

So while Health Net bails, Centene says "Thank you sir, may I have another?".

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Recently I moved a small employer from the fully insured Obamacare plan that was written in 2014 into the Anthem MEWA here in Ohio. As a start up in 2014 the company knew they had to provide insurance benefits to attract the quality employees to make the business successful.

Unfortunately as a new company entering the world of employee benefits, they were forced into the high priced community rated pool created under Obamacare. At the time the idea of using alternative funding arrangements was just beginning to enter the equation and for many insurers they were still a work in progress. Many products were still being developed and few were approved by the Department of Insurance. 

My client did what they had to do and bit the bullet paying a steep price. All the while knowing that I would be coming back this year with high expectations that we would have a few extra arrows in the quiver. Which is exactly what we brought.

I have to say, there was pain in the process. Employees had to complete an online data collection program. FormFire is an encrypted portal for employees that streamlines them through a questionnaire enabling their personal and health information to be integrated into almost any health insurer's application. While time consuming and tedious it's become the only way to effectively receive underwritten rates from insurance companies.

In the end it's the results that matter. A couple of month's worth of headache has resulted in this healthy small employer finding savings. And, they can confirm that there is a significant cost for Obamacare.

In case you want to know how much savings... 

$55,475 to be exact. More than enough to help this growing start up hire an additional employee.

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Almost two months ago, we noted that the "risk adjustment program was designed to dissuade insurers from targeting only healthy people ... The problem is that measuring metrics often encourage companies to optimize their score"

The point being: even when it works (for certain values of "works") it's a giant time bomb ticking away.

And now we learn, thanks to FoIB Allison Bell, that it's about to go off:

"For Congress, putting a health insurance risk-adjustment program in the legislation that created the Patient Protection and Affordable Care Act of 2010 was a no-brainer."

Which is quite apt, don't you think?

The result of mindless tinkering is that "[w]hen insurers are dealing with the ACA risk-adjustment program, the amount of cash they get may ultimately depend on whether competitors make good on risk-adjustment obligations."

That is, they're trusting ion the old adage about honor among thieves, and relying on not just the willingness, but the ability of other carriers to pony up their share. Which, given the current state of the market, is, well, problematic. For example, Meritus Health Partners, Arizona's Co-OP, owes almost $50 million.

The problem?

"Reminder: Meritus has been placed under supervision by the Arizona Department of Insurance."

And that's just the 10th place finisher. Top billing [ed: ISWYDT] goes to Molina Healthcare of Florida, with an estimated tab of almost $219 million. That's a substantial hit, no matter how big you are.

All told, those Top 10 account for some $5.6 billion in risk adjustment fees.

"Bending the cost curve down," indeed.

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Jonathon Gruber, the MIT smart-ass that designed Obamacare, the bill that became law due to "the stupidity of the American voter", has decided to dine on crow.

Kind of.

Gruber claims Obamacare hit its' mark of 20 million people as of 2015 but also admits that maybe they, the architect brain trust, might have missed it by this much . . . .

The rise in the Medicaid rolls has been much higher than expected. In May, 2013, CBO projected that Medicaid would grow by 12 million by 2015 and stay more or less at that level in 2016. In fact, Medicaid had grown by about 15 million by the beginning of 2016 - Poltico

For those with short attention span, all the hoopla and borrowed money spent to throw the health insurance baby out with the bath water resulted in only 15 million people on Medicaid who (presumably) could not access health care that way before.

How much has Obamacare cost?

According to the UK Daily Mail, about $50,000 for every American that gets coverage through Obamacare.

Put another way,

It will take $1.993 trillion, a number that looks like $1,993,000,000,000, to provide insurance subsidies to poor and middle-class Americans, and to pay for a massive expansion of Medicaid and CHIP (Children's Health Insurance Program) costs.

The $50,000 per person figure is a bargain compared to the figure presidential candidate Jeb Bush spent on his failed bid to be known as President Bush III. The Washington Post claims Bush the Lesser spent $53 MILLION per delegate in his run for the rose garden

Meanwhile, back in D.C. the current president has or will spend close to $2 TRILLION dollars on his failed health care plan but will only collect $643 billion in new taxes and fees creating a $1.4 TRILLION dollar loss.

This was the plan that would not add one dime to the deficit.

Not only should we demand that Gruber return his $2.5 million in architect fees but the American voter should demand a recount on all those Obama votes cast in 2008 and 2012.

#ObamacareFail

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#HealthTipOfTheDay

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FoIB Holly R has the latest on the proposed mergers of Cigna with Anthem and Humana with Aetna:

"The Department of Justice announced Thursday that it would file lawsuits against the proposed merger[s] ... there are [currently] five major health insurers in the United States — and if these mergers went through, that would drop to three."

And the numbers are staggaring: if both deals go through those three mega-cqrriers would account for something like half the under-65 population.

On the other hand, FoIB Brian D wonders:

"How can you pass restrictions and rules that push health insurers to the brink of bankruptcy then block insurers to merge to save costs? Could it be you look forward to government take over?"

I replied that this has been the plan all along.

And by the way, Aetna and Humana have announced their plan to fight this decision tooth-and-nail.

Fighting city hall? Hunh.

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Steve Anderson presents this month's round-up of fantastic health policy related posts, with almost Trumpian flair.

Not to be missed.

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Anticipation of huge premium increases in the small employer market has been building since 2013. New rules were to take effect on January 1, 2014 that would eliminate medical underwriting and reduce the number of criteria insurers could use in developing premiums. Insurance professionals, insurers, and organizations such as the U.S. Chamber of Commerce were preparing businesses with less than 50 employees for significant increases to their medical insurance premiums and the potential of losing their plans.

Realizing the potential catastrophe of fully implementing this rule, President Obama had his leaders at HHS issue a letter to state insurance commissioners offering to extend plans that existed prior to October 1, 2013 through 2014. Less than four months later HHS followed up their prior letter with an additional extension lasting through 2017.

The delay has benefited employers and bought insurers time. This has resulted in a series of new plan designs featuring alternative funding arrangements that will help small employers avoid the costly rules associated with ACA compliant plans.

These products include self-funding with lower stop loss deductibles, level funded plans, and Multiple Employer Welfare Arrangements (MEWA). Most of these arrangements aren't new. They have simply been modified or adjusted to meet the needs and budgets that small employers need to retain a solid benefits offering at an affordable cost.

The biggest difference between ACA compliant fully insured plans and all of these options is medical underwriting. Under Obamacare, all fully insured plans for small employers must use adjusted community rating on their policies. The rules of adjusted community rating only allow for insurers to offer different rates for age, location, and tobacco use. Essentially taking the greatest risk factor - medical history - out of the process. The result is ACA regulated plans will increase the cost to employers with healthy employees while limiting the costs to employers with unhealthy employees.

On the other hand, alternative funding arrangements can continue to use medical underwriting to develop rates for employers allowing those with healthy employees to reap the benefits of a lower premium.

With Obamacare's rules on guaranteed issue and no pre-existing conditions, small employers will be able to shift from one arrangement to another based on their employees health risk. This will result in a separation of good and bad. Alternative funding arrangements will be filled with healthy risk and ACA fully insured plans will become a dumping ground full of bad health risk creating a costly high risk pool.

From an employer perspective this gives them the best of both worlds. At least until insurers pull out of the high risk market.

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■ As we noted last month, it looks like the Feds are getting serious about cutting Short Term Medical plans off at the knees. Thanks to a tip from Insurance Services of America, we have some new details:

The U.S. Department of Health and Human Services (HHS) has proposed major changes to short-term, limited duration insurance plans:

• Short-term health policies could be written for no longer than three months, instead of up to a year as is now allowed.

• Consumers would not be able to rewrite the policies.

Just more proof that the ACA was never about insuring people, just controlling them.

Consumers (and, of course, agents) can comment on the new regs until early August.

■ Co-blogger Bob tips us that Palmetto State officials "warn the Obamacare health insurance marketplace is on the verge of collapse." Currently, most South Carolina counties have exactly one choice of insurers: Blue Cross. And it looks like they may be the only one left standing statewide for 2017.

■ Direct Primary Care continues to make inroads. In Cleveland, a local hospital network is offering their own take. Via co-blogger Patrick:

"On Wednesday, [MetroHealth] rolled out a program aimed in part at catering to people unhappy with the cost and complexities of their Obamacare plans. The program, called Select Direct, will allow patients to get primary care services by paying a fixed monthly fee ... You pay the amount and we'll take care of all of your preventive and health maintenance needs"

Which sounds great, since plans are available for as little as $40 a month. It's intended to supplement high deductible plans, or even as an ObamaPlan substitute. It's not clear from the article, but one presumes that it qualifies as an excepted benefit, and thus able to dodge the tax penalty fine.

As with all of these plans, of course, how one pays the oncologist and cardiac unit remains the big question.

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The lie:

The truth:



BusTED.

[Hat Tip: FoIB Holly R]

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Our friend Joe L at Issue Insurance tells us that (at least) 3 life insurers have introduced accelerated underwriting programs that promise to cut both the time it takes to get a policy issues and save wear-and-tear on clients' veins.

For example, Banner Life offers AppAssist, which is available for face amounts up to half a million dollars. It does away with medical exams, labs and doctor's notes. The carrier promises that qualifying applicants "can be approved by the next business day, or even faster."

I must admit, this feature has me scratching my head:

"One inch automatically added to client’s height to potentially boost the rate class"

I mean, I get where that could be helpful in assigning a rate, I just don't get how they accomplish the feat: elevator shoes?

So, what makes one a "qualifying applicant?" Well, that will vary from carrier to carrier, but generally speaking: ages 18 to 50, and the carrier will do a 'script check' (for various medications) and run an MVR (for major traffic violations, such as DUI). Assuming the client is on few (or no) meds and has a clean driving record, he or she should be good to go - quickly.

SBLI and Lincoln Financial offer similar programs, all with the goal of streamlining the underwriting process.

I think this is a good trend: for one thing, faster (but careful!) underwriting means less hassle for the client. Be interesting to see how far this spreads.

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Well, it's been well over two years since our last Food Pyramid update. At that time, chocolate and red wine were the stars of the show, but that was then and this is now:

■ First up, great news for those of us who enjoy "a slice" now and again:

"Hallelujah! Eating pizza can actually help you stay healthy, awesome new study finds"

Turns out, it's more about the amount of sugar in a given food that drives its weight-gain potential. According to the study, "researchers concluded that a high-calorie diet with lower sugar actually improved the children’s cholesterol, insulin levels, liver function, blood pressure, and blood sugar."

Now about those anchovies...

■ In related news, Co-blogger Bob tips us that:

"Pasta may not be fattening after all ... By analyzing anthropometric data of the participants and their eating habits, we have seen that consumption of pasta, contrary to what many think, is not associated with an increase in body weight; rather the opposite"

Now loading it up with extra cheese, bacon and other treats is probably ill-advised, but at least we can enjoy a nice pasta salad (and maybe some of that yummy, healthy red wine).

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Over at LifeHealthPro, FoIB Allison Bell has the story of a woman who doesn't understand the purpose of the product, who's never designed, priced, marketed or sold a plan, who may not have even bought one, yet is called upon to offer suggestions on how to "reform" Long Term Care insurance.

What could possibly go wrong?

Let's start with some basic facts:

First, the primary purpose of Long Term Care insurance (LTCi) is asset protection. That is, as homeowner's insurance protects one's home, LTCi protects one's retirement and other financial assets.

By definition, folks on Medicaid have no such assets to protect, hence no need for a plan. If one has no car or driver's license, why would want want (let alone need) to buy auto insurance?

Second, the primary reason that rates have continued to increase is that the industry made some (very) bad assumptions about retention. That is, they designed and priced the plans similar to disability insurance (close cousin), assuming a similar lapse rate. In hindsight, this turns out to have been a mistake, because insureds have been keeping their plans - even with rate increases - in droves. This drives up claims, and here we are.

Ms Burns offers 7 suggestions about how to "reform" Long Term care insurance. There's a lot of bad advice (and assumptions) but we'll just look at three particularity egregious examples.

First, "(l)et Medicaid help low-income long-term care insurance policyholders hang on to their policies."

Why? If they're already on Medicaid, then they have no use for an LTCi plan (remember, it's primarily designed to protect assets). Now I could see where that might help Medicaid: after all, premiums are a lot less than benefits, and so the gummint would reap some major savings. But that's not the same thing as actually helping policyholders, who might have other uses for those dollars.

Second, "(l)et the government try to recover any long-term care insurance premium subsidies provided after the insured dies, from the insured's estate." There's a lot of stupid packed in here, but I'll try to help her out. To begin with, this is already the law as regards benefits. How's that turning out?  And comparing LTCi with reverse mortgages? Where's Fred Thompson when you need him?

Sigh.

Finally (at least for this post), "(b)uild in transportation and meal support benefits." Right, because adding even more benefits always drives down cost. If there was a market for such cover, rest assured that it would be offered as an option for those who wanted to spend the extra cash. It's called "the free market" and it works.

Next week, we interview an electrician about the best way to install a new toilet.

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■ First up, FoIB Holly R tips us to this terrific news:

"As millions get covered, a POLITICO investigation finds that dozens of the insurers that the health care law depends on are losing money and even abandoning the system"

This is of course not news to anyone that's been paying attention, but that a left-leaning outlet like Politico is covering it is ... suggestive.

■ First, it was sky-miles. Now we learn, thanks to co-blogger Bob, that those highly touted wellness programs are now in IRS cross-hairs:

"Are wellness program incentives taxable? The IRS says ‘yes’ ... In each case, the incentives were deemed subject to income tax."

Thereby further diluting their cost-effectiveness.

Sweet.

■ Finally, long time readers may recall this story from last summer:

"Further investigating – including a review of a Fitbit activity tracker – showed the scene was staged and 43-year-old Jeannine Risley knowingly filed a false report"

The "victim" had staged a fake rape, and was foiled by the Fitbit widget on her wrist.

Now, workers comp claims adjusters, personal injury attorneys and others are using the same technique to catch out potential fraudsters:

"Make that Fitbit a lie detector. Using personal data tracking to investigate claims"

O brave new world...

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As a longtime proponent of the Direct Primary Care (DPC) movement, I found this article quite disappointing.

First, let's start with the fact that a state legislature can't change Federal law. So the fact that The Volunteer State has passed the Healthcare Empowerment Act may well be a great thing, but doesn't change the fact that the ObamaTax is the law of the land, including Tennessee:

"The bill states that DPC arrangements are not health insurance, and are not regulated by the Department of Commerce and Insurance."

How a given state chooses to regulate its citizens and industries is, of course, entirely their choice, but the ACA has specific verbiage relating to DPC, and these aren't open to state by state interpretation.

In this case, the ACA explicitly states that the "Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan."

The next item with which I have issues is this:

"If you have primary care coverage through your insurance but also sign up for DPC, are you paying for coverage twice? Technically, yes."

Um, there's no "technically" about it: you're going to pay both the DPC fee and the insurance premium (if you want coverage for the aforementioned oncologist, etc). Now, I don't actually have a problem with this: it's the price one pays for accessing the DPC model. There are a lot of benefits to the DPC model, to which the article alludes; I just don't understand why the author found the weasel wording necessary.

YMMV.

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Recently, I was obliged to take my triennial anti-money laundering refresher course. As these things go, it's not exactly rocket surgery, but as I waded through the questions and scenarios, I became more and more incensed at the presumption on display by our Betters in DC.

So, of course I wrote a post on the subject but, upon reflection, decided it would be better suited for a more politically-oriented blog. Fortunately, I've come to know and respect the gentleman under The Political Hat, and he's graciously agreed to publish the post on his site.

Click here for the rest of the story...

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An anonymous (but reliable) source let me know that Northwestern Mutual is contemplating its first Long Term Care insurance (LTCi) rate increase - ever - "sometime this year." Indications are that premiums on in-force plans will go up 15-22%.

The carrier's been writing LTCi for a while:

"QuietCare® was first introduced in 1998"

According to my source, they've historically had relatively higher rates than their competitors. On the other hand, their financials are among the best in the business.

Last time we looked, Northwestern held down 3rd place (out of the Top 10), with John Hancock and Genworth occupying the two top spots.

Oh, how times have changed:

That's from the 2014 survey (most recent I could find), courtesy of Highland Brokerage. I knew that the industry had changed in the past few years, but hadn't realized just how drastically.

And speaking of Long Term Care, "[o]nly 36% of Americans are saving for senior care:"

A properly structured LTC insurance policy can help fill (or eliminate) the gap.

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"There’s been a lot of talk about the 'public option' all of a sudden."

And it's still the same bad idea it's always been.  

[From July 11 Wall Street Journal via Instapundit - with thanks.]

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Over at LifeHealthPro, Ben Steverman has an interesting article about the challenges facing folks involved in the (medical?) marijuana trade, which is now legal in a handful of states. Even though these folks may have never even used their product, they're apparently having a hard time securing the coverage they need to protect their families in the even of the untimely demise.

Derek Peterson, for example, is "the chief executive officer of Terra Tech, a publicly traded pot company based in Irvine, CA." When he recently applied for life insurance coverage with Mutual of Omaha, the underwriter put the kibosh on his plans, stating that:

"We have discontinued the processing of your application for insurance due to company policy. We cannot accept premium from individuals or entities who are associated with the marijuana industry."

Okay, they're certainly within their rights to set underwriting guidelines, but this seems perhaps a bit heavy handed. It's not stated, but we can infer from the article that he wasn't actively using marijuana, merely involved in its production and distribution.

[ed: You'll notice that I didn't say "legal" production and distribution. We'll circle back to that momentarily]

The article quotes  Loretta Worters, spokesperson for the Insurance Information Institute, who observes that "[t]he problem from a life insurance underwriter’s point of view is that, unlike tobacco, there isn’t a lot of data available to assess the risks of coverage for marijuana users"

But this begs the question, since there's no indication that Mr Peterson used pot, either in the past or currently.

So I reached out to some of my own sources; one, a life insurance underwriter, told me that "I personally have not had to underwrite a client who was a pot store owner, but it would be a situation where it would be case by case review.  I think the article hit the nail on the head when she stated that there isn’t a lot of data available to assess the risks of coverage."

She pointed out that there are other industries that carriers tend to "underwrite a little more carefully- people who own bars, gun shops…..  and that again is just because of the statistics and mortality studies that we have that these people have increased incidents of alcoholism, bar fights, being robbed at gun point."

Which makes a lot of sense, but I still had my reservations.

Until I heard from a good friend who's also the field rep for one of our carriers, who I think really pegged it:

"While pot may be legal in certain states, it's still a Federal offense, and we tend to shy away from folks that are actively - and publicly - committing felonies."

Makes sense, no? Simple, straightforward, and cuts right to the chase.

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Looks like Oregon's Health CO-OP's suit lawsuit against the Feds has come to naught. As co-blogger Patrick reported earlier this year:

"Oregon Co-op Health Republic has filed a $5 Billion dollar class action lawsuit on behalf of all of the insurers who didn't receive funding from the Risk Corridor program"

How'd that turn out?

Not so great:

"Oregon’s Health CO-OP will shut down at the end of this month after the company dramatically overestimated the amount of financial support it would receive from a federal program."

But hey, if you like your plan...

[Hat Tip: FoIB Catherine S]

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For certain definitions of "winning:"

(Courtesy Fox News Research)

Methinks that Open Enrollment v4.0 will not be pretty.

[Hat Tip: FoIB Rich W]

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FoIB Allison Bell has an excellent overview of proposed new IRS rules regarding employees who may qualify for subsidies. There's a lot of good stuff here, but I want to focus on two items that we'll call problematic:

First, regular readers know that subsidy calculations are, at best, a crapshoot. That is, very few (if any) people know what their next year's income is going to be with total accuracy. As we've noted time and again, Ouija boards lack dollar signs. So the Rocket Surgeons in DC© have decided to "to get tough about clawing back premium tax credits provided for taxpayers who appear to have "recklessly or intentionally" provided inaccurate information about how high their future income might be."

Heck of a lot of room for creative interpretation on their part, no? Perhaps if one just claimed there was no intention to overestimate.

And second, there's actually an appeals process for folks who believe they've been wrongly denied a subsidy, but it's apparently quite time consuming and as a result, "resolving eligibility appeals has been taking so long that key premium payment deadlines have passed."

So what's their solution?

This is pure genius: "Officials say they want to clear up those conflicts by giving a taxpayer who wins an eligibility appeal up to 120 days after the decision has been made to pay the taxpayer's share of the premium bill."

Are they not aware that the maximum grace period for folks buying subsidized coverage is only 90 days? How are they going to enforce this? It's almost as if they have no idea what they're doing.

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Working on an interesting (well, to me, anyway) life case:

Gentleman is 57 years young, and recently retired(!). When he chose his pension payout, he was between wives, so chose the full amount, with no "survivorship" option. This guaranteed the highest payout amount, but also meant that once he expired, so did his pension. Now he's got a new bride, and is (justifiably) concerned for her financial well-being should he shuffle off this mortal coil.

This is called Pension Maximization, which is simply using life insurance to offset any such loss. Generally speaking, this is a pro-active strategy; that is, one does all the calculations and underwriting beforehand. But there's no reason that we can't accomplish the same goal re-actively, as in: now.

Oh, one more variable: his advisor suggested that he look at $500,000 of term, locked in for either 10 or 15 years, but then came back and wondered if we could also write an additional $250,000 five year term plan. I explained that these are in short supply (for a variety of reasons), but that also that there's a simpler and more cost-efficient way to accomplish this goal: write the plan with a $750,000 face amount and then, in 5 year's time, reduce that down to $500,000.

This avoids duplicate applications (and perhaps exams) and policy fees. It also adds flexibility: what if they end up needing/wanting the additional amount for 6 or 7 years instead of 5? This way, they can reduce the death benefit at 5 years, or 8 years, or not at all.

Pretty nifty, no?

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This year's crop of National Underwriter Industry Elite Award winners has just been announced. As a past winner myself, I was pleased to see that (finally), other actual agents were included this year, including:

Leasha West, a retired Marine and successful agent who also runs a task force to help other vets, and Ron Alexander, who's worked to bring about significant marketing innovations. Brooklyn's David Simkowitz focuses on high net worth clients, and is also known for his willingness to mentor others.

Mazel tov, and welcome to the club!

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■ For the most part, "Limited Benefit" (aka MiniMed) plans have been verboten by the ObamaTax. Which is a shame, since they could serve a very vital service, such as Direct Primary Care supplements (among other uses). There may be some good news ahead, though:

"A federal appeals court says the U.S. Department of Health and Human Services has no authority under the Affordable Care Act to regulate how consumers use fixed indemnity health insurance"

This would seem to open the door, but I'm not holding my breath just yet. Time will tell whether or not this actually gains traction.

■ I'm not generally a fan of dental insurance, but dental health is still, well, health, so this item caught my eye:

"[R]esearchers have come up with a new kind of biomaterial that not only encourages the natural regeneration of teeth, but also might eliminate root canal procedures for good."

This may not be great news for dentists who count on root canals as significant portions of income (NTTAWWT), but seems promising for those of us who don't relish the thought of oral surgery.

■ Hard to believe, but it's been over 8 years since my mother passed away. At the time, I noted with gratitude the ceaseless efforts of hospice angels, er, caregivers. I couldn't imagine how draining - and, ultimately, rewarding - there work is, but (thanks to FoIB Holly R) the New Yorker gives us a glimpse:

"She sees her work as preparing a patient for the voyage he is about to take, and accompanying him partway down the road. She, like most hospice workers, feels that it is a privilege to spend time with the dying"

Angels among us.

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Connecticut joins the parade of failed Obamacare exchanges. Unexpectedly.

The reason?

"The move stems from an order, made Thursday, [June 30] that the company pay $13.4 million to the federal Centers for Medicare & Medicaid Services as part of the Affordable Care Act’s Risk Adjustment Program."

Even when Risk Adjustment works as designed . . . 

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This never gets old:

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It's no surprise that ObamaPlan enrollment numbers continue to decline, but the sheer magnitude of that drop off is surely something to behold. Via the fine folks at HotAir, we learn that:

"Nearly 1.6 Million People Dropped Out Of Obamacare This Year"

That represents a 13% attrition rate from the less than 13 million suckers folks who signed up for subsidized plans so far this year.

And the best part?

"The pattern of attrition is not new, and has been seen each year"

Winning!

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■ First up, the folks at Employee Benefit News ask a rather interesting question:

"Should HSAs and 401(k)s be more closely linked?"

My first reaction was "what part of health savings account" did you not understand?" But then, when one thinks about it, it begins to make sense; after all, if one stays healthy and the account continues to grow, why wouldn't one wish to maximize the return on the excess amount?

And even with the ObamaTax train-wreck, the popularity of the underlying plans continues to grow:

So, something to consider.

■ And thanks to FoIB Jeff M, we learn that it's not just enrollment in HSA's that's skyrocketing:

"It's Working: Blue Cross/Blue Shield Reports Heavy Obamacare Losses Across the Country"

Bending the cost curve down: How does it work?

■ And finally, via our friends at Consul Insurance, a tragic event raises some pretty interesting claims questions:

"Tesla’s Autopilot Has Its First Deadly Crash"

Apparently (and I hadn't really been following this), Tesla's Model S has the ultimate cruise control feature: an autopilot mode. Unfortunately it still has some rather, um, significant bugs to be worked out:

"Neither Autopilot nor the driver noticed the white side of the tractor trailer against a brightly lit sky, so the brake was not applied"

Seems like there would be a host of insurance-related issues here. The folks at Consul tell me these include "product liability, BI/PD, manufacturer vs operator, a bunch of issues to be settled."

Indeed.

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