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Health Savings Accounts (HSAs) are generally pretty transparent; after all, there aren't a lot of moving parts: a compliant health insurance policy, a properly administered savings account (typically help at a bank and using a debit card for access). Pretty simple, no?

Sometimes, though, things aren't as easy as they may at first appear. From the mailbag:

"Thank you for reaching out to me. My husband will be 65 in a few months. I have a HSA account. He and our daughter are on my account.  My question: is he able to enroll in Medicare and also use the HSA account?  He does not contribute to the  account."

Pretty straightforward, although I did have a few questions to ensure that we were on the same page. Once those were cleared up, it was a simple matter to reach out to our own Gurus of all things HSA, the fine folks at FlexBank, who assured us that:

"The wife can use the HSA funds  for her husband's qualified medical dental vision and hearing expenses. She cannot use it for his Medicare premiums unless she is also age 65."

Interesting, no?

What's sad is that there aren't any Medicare HSA options. One would think they'd be ideal for healthy seniors.

Oh, well, opportunity lost.

[Hat Tip: FoIB Jeff M]

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Last week, Medical Mutual of Ohio announced that it would pay no commissions on plans written for folks coming to them from InHealth. They've since clarified this position:

"We would like to clarify that renewal commission will be paid on business that renews with Medical Mutual for a January 1, 2017, effective date, that was originally transitioned as the result of a delinquency proceeding."

Which is nice, of course, until one realizes that this does nothing to address the underlying, substantive issue, which is that the carrier is still charging for those commissions but then not disbursing them, effectively defrauding their new-found clients through the end of this year.

Underwhelming, no?

To be fair: Other carriers, such as Anthem, are refusing to pay any commissions on plans written between Open Enrollments, period.

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So it's been a week, and I sent this out to my InHealth clients, and though IB readers might find it interesting, as well (seeing as how it's likely they're not going to be the last Co-Op to go kaput):

Good afternoon!

So, we have a little more info, and further clarification should be forthcoming.

First, you can keep your IH plan through the end of the year, which may be helpful if you've already met a substantial part (or all) of your deductible. The premium and benefits won't change, but the overall maximum benefit will be $500,000 (as opposed to current unlimited). I think it's a personal decision as to whether or not that's a reasonable roll of the dice.

Second, and related, it's not yet clear whether moving to another carrier will necessitate a new deductible. As I've told those of you who've asked, I'd guess "yes," but we don't know that for sure (yet).

Third, if there's any 'good' news here, it's that we don't have to make a decision about any changes for a few weeks yet, and I would advise holding off on that until we hear more from the Department of Insurance, and as we learn more about how other carriers are treating this. As an example, Medical Mutual has said that it won't pay any commissions on policies written on former IH clients. Make of that what you will.

So, that's where we are today, and I will keep everyone posted as we go forward. Please know this: no matter what happens with carriers, commissions, etc I am proud to be your agent and I will not leave you hanging.

Have a GREAT weekend!

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■ First up, via FoIB Jeff M, this little factoid:

"North Carolina Leads The Nation In Health Insurance Mandates" - BOLD

Most folks likely know by now about the ten Essential Health Benefits that make up the core of ObamaPlans, but the Tar Heel State's Powers That Be have decided that these don't go nearly far enough, and have imposed "56 health coverage mandates."

All "free" of course.

■ We've noted before the rather incestuous relationships enjoyed by folks in the upper echelons of the health insurance industry and those that "regulate' them. FoIB Holly R tips us to one about which we were unaware:

"Cigna lobbyist-turned-regulator playing the key role deciding if Cigna & Anthem can merge"

Now, we'll pass no judgement here regarding the merits of such a merger; we'll just note the old adage about foxes and hen houses.

■ The folks at United Healthcare have kindly sent us the latest schedule of first-dollar ("free") Preventive Care benefits released by the Rocket Surgeons in DC©. It includes adult blood pressure and sugar screening, and of course a litany of women's health bennies, including for iron deficiency and breast cancer.

What it still doesn't include is any such benefits for men. Why the misandry. HHS?

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As regular readers know, Ohio's O'Care Co-Op, InHealth Mutual, bit the dust last week. This morning, Medical Mutual of Ohio let us know that they won't be paying commissions on any business that comes to them from InHealth.

I just spent a good chunk of the morning going 'round and 'round with the wonderful folks at the Department of Insurance, who kept shunting me from one department to another, insisting that this somehow isn't fraud, and then dumping me at a voice mailbox.

Look, this is so simple that even a government drone should be able to understand it: Medical Mutual's rates include a commission, they've announced their intention to keep that commission, they've not adjusted their rates to reflect this, therefore they are defrauding any InHealth Mutual client who switches to them.

But apparently our Betters in Columbus just don't care.

Your tax dollars at work.

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David Harlow hosts this week's roundup of interesting and provocative health policy related posts. From Ibsen to telemedicine to the NFL and beyond, you're sure to find something that piques your interest (fancy that!).

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As in "rocket surgeon" Robin Hood:

"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"

Let's unpack this, shall we?

First, as we've noted before, "carriers have an incentive to make their own insureds look as sick as possible" if they want in on that sweet, sweet risk adjustment money. And let's face it, there's precious little they can do about making this happen; after all, there's no underwriting so they're actually shooting in the dark about what kind of demographic they're appealing to.

And second, it's not as if this is a deep, dark secret: heck, we've been blogging on it for years, as have many, many others.

Frankly, I fail to see the problem: carriers are simply following (willfully stupid) rules as intended, with entirely predictable results. When you incentivize a behavior, you tend to get more of it, no?

[Hat Tip: FoIB Joseph Snable]

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