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While we're primarily focused right now on Open Enrollment v7.0, November is also a time to be thinking about Long Term Care, both its cost and how to fund it.

One issue is a common misconception that getting older automagically means a decrease in one's quality of life:

"Most older adults and caregivers mistakenly believe that sharp declines in quality of life are inevitable with age ... The majority of seniors think that depression, dementia and lack of mobility can’t be helped."

But are they correct?

Not necessarily:

"Nearly 40% of respondents are not aware that certain prescription medications can impact cognition, and only half know that certain medicines should be avoided as a person gets older."

And that's just the tip of that iceberg. Click on through for more.

Oh! And click here for the survey results themselves.

[Hat Tip: FoIB Randy G]

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What started out as a dream cruise became a nightmare hospital stay for one Atlanta-area couple:

"The two sailed out of Galveston, Texas, on Nov. 11 .... Days later, [Stephen Johnson] went into diabetic shock."

And as if that wasn't bad enough, the ship's doctor recommended that he be airlifted to a hospital in Progreso, Mexico. What happened next should come as no surprise to regular readers:

"When it came time to check out of the hospital, however, the two were not allowed to leave without paying their $14,000 hospital bill in full."

To be fair, the hospital is claiming that it's not the money, but the fact that, in their opinion,  Mr J is still too ill to travel. The good news is that actor/director Tyler Perry has stepped up to cover their bill.

There are actually a number of issues here, pretty much all of them falling on Mr J. For starters:

"Austin said her fiance does not have private insurance."

Why not?

After all, it's the law, right?

According to sources, Mr Johnson is 31 years old. We'll assume that he doesn't smoke, and that since he's wealthy enough to self-insure and pay for a cruise, doesn't qualify for a tax credit (aka "subsidy). A quick trip to 404Care.gov yields this (for example):

An Anthem Bronze plan with a $5,500 deductible is about  $11 per day. Seems pretty affordable to me.

Of course, we already know that most American health insurance ends at the border, which is why we always recommend an inexpensive travel medical plan. The good news is that that's also pretty affordable, as well. We'll assume a 10-day cruise:

Our friends at Global Underwriters offer a "Diplomat International" plan with $1,000,000 of coverage and a $2,500 deductible for $15.

Looks like Mr J chose poorly. 

Oh, and by the way: It took me less than five minutes to track down his age (already know he was from Sandy Springs) and run 404care.gov and travel medical quotes. All these so-called "journalists" had to do was call their own freaking agents. But here we are, doing the job "journalists" can't be bothered to do.

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So, FoIB Holly R sent this along:

"Every NICU bed at this hospital is equipped with a webcam so parents can always check on their babies."

Hunh.

I replied:

"I like that!

Although: I guess there could be privacy issues?"

Parents can stream the live feed to their phone or other device. The story doesn't say whether or not the feeds are monitored at the hospital, but one presumes this would be the case.

My concern is that with the spate of hospitals and medical equipment hacking, is there a legitimate concern about this from the parents' perspective?

Whaddaya think?

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Heh:

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From a friend's daughter:

"Hi, I'm Vanessa Leahr and I live with multiple chronic health conditions including a connective tissue disorder called Ehlers-Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, Complex Regional Pain Syndrome, Gastroparesis, and more.

 I recently  started an online shop called DAZZLING THEM: DESIGNS BY VANESSA L. as a creative way to make money to help pay for my medical expenses and raise awareness for my conditions. 

Please check out my shop, and share this link with friends and family to help me grow my business."

On Vanessa's behalf, thank you for taking the time to read this message, and I hope it piques your interest.

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Britain's Much Vaunted National Health Service© continues o cover itself in .... glory (for certain values of "glory"):

Or left in hallways to die. https://t.co/LJvZpXKyIg

— Beau Geste (@BeauGeste11) November 21, 2019

But hey: Free!

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Heh:

#Medicaid4ALL

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It's been a while since we last visited MLR (Medical Loss Ratio):

"In case you didn't know, the ACA requires carriers to pay out (at least) 80% of premiums collected in claims. For large groups, that requirement is 85%. Anything less and they have to send the difference to their insureds."

The idea was to encourage (require) carriers to be more carful stewards of the premiums they receive and their obligation to pay out as much of those in claims as possible.

Anyone else see the glaring logical fallacy here?

Well, FoIB Ed Swan sure did:

Understanding MLR.

15% of a higher number is...a higher number. This is why insurance carriers have no incentive to negotiate lower prices for healthcare services. They just pass the costs back to the insured in the form of higher premiums. https://t.co/dDEcS9fa4E

— Ed Swann (@Epic_Ed) November 8, 2019

#PieceOfThePie

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Our friend Rick B sends us the link to this satirical(?) piece on modern health "care:"

"Supreme Court Allows Victims Of Heart Disease, Obesity To Sue Utensil Manufacturer"

He points out that there are some very real issues at play here:

"I know this is a joke but interesting idea for a blog post. Who is responsible for us?"

A most cromulent quesiton, no?

#Medicaid4All

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Hunh:

[click to embiggen]

Let's see how that compares to last week.

[ed: recall that week one comprised but 2 days]

Plan Selections were up an average of 23%/day, and the number of New Consumers also increased (by about 15%/day). Current policyholders renewing coverage were up by almost 25%.

On the other hand, Window Shoppers fell an incredible 57% per day (to be fair, not sure that's meaningful, yet).

Interesting, no?

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This is so cool:

"Quick-thinking hunters in central Michigan have rescued two deer who literally became locked in battle."

And Insurance Agent Mark Johnson saves the day.

Kudos!

[Hat Tip: Ace of Spades]

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From our friends at Global Underwriters:

"Each year the number of people traveling for business purposes is astonishing. The Global Business Travel Association counts over 488 million trips taken annually. Each year business travelers take an average of 12 trips, typically lasting at least 5 days. An estimated 1.3 million business trips occur daily in the U.S. alone. These figures are expected to grow another 7% this year.

Even with video/web conferencing, online meetings, and daily conference calls business travel continues to increase and is vital to the success of your clients company. Hectic schedules, missed flights, transportation issues, and hotel problems are the least of the employees' worries. Many employees are citing concerns related to personal security, terrorism, political unrest and infectious disease epidemics. 

It's also crucial that companies and organizations embrace Duty of Care obligations and take the necessary steps to reduce potential dangers or problems that could occur while their employees travel. Employers need to have a well communicated plan in place and part of this plan is providing Business Travel Accident (BTA) insurance for their employees. BTA insurance is an inexpensive benefit that supplements any employee benefit program. This World Class Protection is designed to offset the risk and potential loss of a key employee(s) and to compensate families of employees for their loss of income due to accidental death or permanent disability of a loved one."

If international business travel is on your itinerary, this is must-have info.

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Fresh off the presses:

Just Released: 2020 LTC insurance premium deduction and tax-free benefit increases! https://t.co/GFpR5KIDrX pic.twitter.com/9viLCFMYY1

— Bill Comfort, CLTC® (@comfortltc) November 7, 2019

Potential good news for folks considering an LTCi purchase.

Not sure about timing? Well, consider this timeless post from our friend Herman Bruns:

"As more and more baby boomers become aware of the devastating financial and emotional effects that a long term care need can have on their family, the average age at which people purchase LTC insurance has been steadily dropping every year."

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For plan year 2020, history repeats:

"The other issue is that, at least in Ohio in 2019, all plans are built on an HMO chassis, which means basically zero out-of-network coverage."

One way carriers have found to reduce their costs has been to offer ever-shrinking networks. For some, this isn't an issue, but for many, who have longstanding relationships with their current providers, this can be a problem.

Take, for instance, Larry: he's a long-time client, lives up in the Cleveland area (Geauga County). As with most of the state, almost all of the plans available on the 404Care.gov site are offered by erstwhile Medicaid carriers, with two notable exceptions: Medical Mutual and new kid in town Oscar Health.

Larry's in his late 50's, and has some medical issues that make the Guaranteed Issue/Pre-ex coverage available on ACA plans attractive. He also has some specific doc's that he likes, including some at Cleveland Clinic.

Now, it turns out that The Clinic is in-network for only one carrier here: Oscar. And the question arises, how much is that relationship worth, in actual dollars? I have long wondered this, but until now had no way to quantify it.

Now, I can, and it's breathtaking:

[click to embiggen]

The  plan on the left is from CareSource (one of the aforementioned "Medicaid carriers") and the one on the right is from Oscar. The only substantive difference other than the fact that the latter actually has higher potential out of pocket exposure) is that Oscar includes the Cleveland Clinic, and CareSource does not.

So, is The Clinic worth $3,600 a year?

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Hunh:

"In week one of the 2020 Open Enrollment period, 177,082 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only two days long this year - from Friday to Saturday."

This tracks with what we've seen in previous years: a big rush up front, then things taper off, and a last-minute flurry as folks actually pull the trigger the last few days of Open Enrollment.

Of course "selecting" a plan doesn't necessarily mean buying one: just as with eBay and Amazon, people often leave their shopping carts unclaimed. Which we can sort of see in this infographic:

[click to embiggen]

I must admit that I'm puzzled by what, exactly, "Consumers on Applications Submitted" means.

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Courtesy FoIB Dino R:

"NHS waiting list hits another record high: 4.4million people are now waiting for routine operations as the figure is the worst ever for a third month in a row"

And for those right-brained among us:

 [click to embiggen]

But wait, there's more:

NHS 'abandoning' thousands by rationing hepatitis C drugs https://t.co/e25kltBgiA. @JoeSilverman7

— Jim Schneider (@vaoncsurgeon) November 4, 2019

But hey: Free!

#Medicaid4All

 

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Regular readers may recall this from a few years back:

"Due to the significant changes carriers have made to their compensation schedules (aka commissions), I don’t believe that I can continue to offer the kind of comprehensive service to which I, and you, have become accustomed."

I still do the annual re-certification, and dabble in the individual market as needed (current clients, referrals, that kind of thing).

Recently, Sen Iron Eyes Cody Elizabeth Warren had this observation about folks like me under her #Medicaid4All plan:

Q: Where do those who work in health insurance go when private insurance is eliminated?

Sen. Warren: "No one gets left behind. Some of the people currently working in health insurance will work in other parts of insurance. In life insurance, in auto insurance, in car insurance." pic.twitter.com/KGJ4Eg9VKR

— The Hill (@thehill) November 2, 2019

Hunh.

It's true that home and auto insurance share a common principle:

"Yes, they are both predicated on the principle of "indemnification," but then so are disability and homeowners insurance."

But that's where it ends. For one thing, they are two completely different licenses, and markets, and marketing strategies.

For another, she seems to be forgetting all the support folks at various home offices, not to mention plan administrators and the like. And of course, this also means the end of Medicare Supplement and Advantage plans (why does her party keep throwing seniors under the bus?).

And, of course, there's the matter of how much this while shebang's going to cost.

But hey: details, shmetails.

[Hat Tip: FoIB Bob G]

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So last week my Better Half and I took a long-anticipated, week-long trip to The Big Easy. I had been there as a very young lad, so no real memories, and she had never been. Had a great time, ate too much really good food, and spent some time in some amazing museums (among other things).

Mid-week we spent the day at the United States World War II Museum. We spent the day, but could easily have spent several more. Just extraordinary.

But what was very special was the completely unanticipated personal connection to one of the exhibits.

As we rounded a corner, we found a display of a carpenter's tool kit, and a plaque explaining it:

[click to embiggen]

The gentleman's name (redacted for privacy reasons, which you'll soon understand) rang a very loud bell:

Some 30 years ago, one of our carriers imported a new rep from Louisiana. Roger D and I soon became fast friends, and he's since become my local Medicare "guy." His last name is unusual for Ohio, but maybe not for Cajun country, and it appeared on that plaque. So I texted him the pic, and asked "Anyone you know?"

He replied "Wow, will have to ask my Dad about this."

A few minutes later he texted again:

"Turns out this my grandfathers brother. My dad knew about him and told me stories about how he went to Hawaii to help rebuild. Came back and opened several grocery stores. Thanks for sharing this photo."

Wow, traveled over 800 miles for that connection...

Worth the trip all by itself.

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$52 trillion is the amount Elizabeth Warrens campaign is conceding her Medicare for All proposal will cost over its first 10 years.  That would be $5.2 trillion each year.  All of this ignores inflation which Senator Warrens plan would supposedly make vanish.

Anyway, after the laughter subsided, I wondered how to express $5.2 trillion in more understandable terms.    Here’s one way.

The CBO projects 2019 federal spending to be about $4.4 trillion. 

Senator Warren is saying that the projected annual cost of her plan is greater than this year’s total annual federal expenditures.

Show of hands please.  Who wants your taxes more than doubled? Anyone?  Anyone?

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