Obamacare is Fading but Not Going Anywhere until 2019

New tax legislation does away with Obamacare’s mandate that one must be covered by health insurance or pay a fine (“tax”… thank you Chief Justice Roberts), with exceptions. BUT, the tax does not go away until January 1, 2019. Most other Obamacare rules and regulations remain in place for now…like a nagging back ache that just won’t go away.

There may be some wiggle room for those facing the tax. Personally, I am not so sure that the IRS has the will or incentive to pursue collecting it. The Patient Protection and Affordable Care Acts (Obamacare) were poorly constructed pieces of legislation, leaving IRS no mandate to collect the tax other than by deducting it from a person’s income tax refund…so, if a scofflaw has no refund coming…no way to collect the tax. Let’s see how that plays out in the near term.

Carpe Diem

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Get Your Ducks in a Row for the New Year

For most of us the week between Christmas and New Years Eve provides a few days to decompress, make some plans for the coming year, review and toss or delete old files, set goals and objectives for the next several months, recharge and seize the new day coming. Be sure to include a conversation with your insurance agent.

Set up an appointment to review your insurance policies to make sure all are up to date and still adequate to meet your needs. Times change, and your insurance policies must be updated to reflect those changes. Doing that review will not cost you a dime, and may save you, and those you care about the most, a lot of grief at some time in the future.

Example: In 1996, Bill named wife, Sally, as Beneficiary on his $2,500,000.00 life insurance policy. Bill divorced Sally in 2001, after she cleaned out their joint checking account and ran off with Bill’s best friend, Benedict. Bill later married Jill, his old high school sweetheart, during the holidays in 2015. Returning from a New Years Eve party that year, Bill and Jill while sitting in their car waiting for a red light to turn green, were rear ended by an eighteen wheeler whose driver had dozed off. Bill did not survive. Jill was severely injured resulting in lifelong disability…Bill had not gotten around to removing Sally as beneficiary on his life insurance policy then naming Jill in her place. Guess who ended up with Bill’s $2,500,000.00 death benefit? You guessed it…Sally, not Jill, his now disabled widow.

Life Insurance policies are contracts, (Unilateral contracts), and the named beneficiary gets the cash, not always the intent of the now deceased insured person.
Call your insurance agent soon to audit and make recommendations about all of your insurance holdings. You may have more than one agent, one for property/casualty and one for life/health. Call both for a review. You, and specially those who out-live you, will really be glad you did.

Carpe Dien

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Aging Into Medicare Soon?…Some Information You Can Use

If you are approaching age 65, start doing your homework on Medicare now. Visit Medicare’s web-site: www.medicare.gov. That resource has been around for many years and contains a treasure trove of information important to you, written in easy to understand language…no cumbersome “government speak”.

Medicare pays a significant portion of Medicare beneficiaries’ healthcare expenses; however, those beneficiaries also have skin in the game. View Medicare as a brick wall shielding you from your large healthcare bills…however, with a significant number of bricks missing. it’s up to you to fill the healthcare expense holes in the wall when you have a claim.

Fortunately, very affordable insurance plans are available to fill the gaps in Medicare…some require monthly premiums, some do not. Some require annual deductibles, co-payments and co-insurance, some do not. It is important that you learn all of your options as a Medicare beneficiary, and to your advantage to discuss them with an insurance professional.

Ask your life insurance, or other, agent to recommend an agent or broker who is qualified to provide Medicare-related insurance plans. Unlike other insurance brokers, those who provide Medicare insurance plans are prohibited by Medicare from calling you without having your prior permission to do so. By the way, if a person knocks on your door, attempts to solicit you, or rings your phone to pitch a Medicare insurance idea, without your having given them prior permission to do so, they are breaking the rules and could loose their license, job and worse. They are also demonstrating to you a major character flaw…so send them packing. There are bad apples in every basket.

If you are a Florida resident I can assist you with your Medicare planning statewide, otherwise seek assistance locally.

Carpe Diem

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Qualifying for Medicare Soon?

Most of those reaching age 65 this year and those having received Social Security Disability Benefits for at least 24 months may qualify for Medicare benefits. There are always exceptions, but let’s skip those for the moment.

If you have been receiving Social Security Disability Income Benefits for at least 24 months, you will be enrolled in Medicare Parts A & B starting in month 25. However, even if you are enrolled in your state’s Medicaid program you may have out of pocket medical expenses to pay because Medicare does not cover all of your healthcare costs.

If you are not disabled and have been paying Medicare taxes during you working years you qualify (with exceptions) for entry into Medicare on the first day of your 65th birthday month. However, if your birthday falls on the first day of your 65th birthday month, you qualify for entry into Medicare on the first day of the month immediately preceding your birthday month.

Medicare Part A covers you as a hospital in-patient plus a couple other items. Medicare Part B provides coverage for medical expenses incurred while not an inpatient in a hospital…visits to doctors’ offices, lab tests, x-rays, etc., OTHER THAN outpatient prescription drugs. Those fall under Part D of Medicare.

In short, Medicare picks up a portion of a beneficiary’s healthcare and out-patient prescription drug costs, but not all of such. After Medicare pays its part of the bill, it is up the the Medicare beneficiary to pay the remaining balance.

Medicare is a far reaching piece of legislation going back to 1965, and I would not attempt to cover all the bases here. Instead, Medicare provides information via its web-site, www.medicare.gov, which, unlike healthcare.gov, actually works. To learn all you have always wished to know but were afraid to ask about Medicare, go to www.medicare.gov, and surf there to your heart’s content.

If you are within three months from your 65th birthday, you may enroll now in Medicare on line at medicare.gov…and you may still enroll there until three months after your 65th birthday month.

Each year I meet with many who are approaching Medicare eligibility, to remove its mystery for them. Do not agree to talk to anyone phoning you without your prior permission, or showing up on your door step to talk about Medicare. Those people are breaking Medicare’s rules and exposing their dishonesty to you. Insurance agents like me are not to contact you directly without your prior permission. Doing so could cost me a fine or result in loss of my license. Medicare rules are there to protect your privacy and to save you from being hounded by door to door peddlers. Instead, deal with a qualified agent certified by his/her state and insurance company to discuss Medicare insurance plans with you….while you’re at it, ask to see their license and certification form. If they can’t produce both, show them the door.

Carpe Diem

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Own a small business? Thinking about owning one some day?

You need to know about Florida’s Small Business Resource Network (sbrn.org)…your resource for professional business services provided by experienced and vetted accountants, commercial lenders, attorneys, consultants and insurance brokers…plus local, state and federal agencies in support of small business…watch these videos to learn more:



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Health Insurance in 2017: One Foot on the dock…One Foot in the Canoe

Fact of life: The Republican nominee won in November and was inaugerated on January 20th. Nothing is going to change that, so all of us must move on with our lives, look ahead and concentrate on doing what is best for ourselves and our families, control what we can control and worry less about things out of our control.

As the new administration in Washington considers its options regarding changes to current health insurance law, ignore most of what you read or hear coming from news papers, TV, and on-line media (unless it’s from me, of course), because way too much of it is speculation and BS designed to keep you coming back, agitated, or pushing you to buy the soap they are selling.

Always remember, the Washington, D.C., crowd are first and foremost Politicians. Listen to what they say but watch them to see what they do. The two don’t always equal each other. (Keep that in mind when the next election rolls around.)

I expect to see a series of immediate steps rolling back the most unpopular aspects of the Patient Protection and Affordable Care Acts (Obamacare)…the tax penalty for not buying health insurance, the closed annual enrollment period, forced coverage for maternity/juvenile vision/dental care on all health insurance plans regardless one’s circumstances.

I expect to see leaving current health insurance policies in a status quo position until at least 2017 year end, to avoid the disruption which would occur otherwise.

I expect to see a return to more traditional health insurance underwriting criteria, allowing insurance companies to offer their products in exchange for a more rational purchase price, thus allowing competition to return to the markerplace…and present premiums to decrease over time.

I expect to see a separate safetynet program for those having significant health issues which, in the past, would have prevented them from obtaining health insurance.
Pre-Obamacare, most states had safetynet programs, but most of such were severely underfunded.

Please keep in mind that owning health insurance is not a right. Keep in mind also, access to Health Care, rather than health insurance, was mandated by federal law years prior to Obamacare.

I expect you will hear a lot about being able to buy health insurance across state lines. That is a self-defeating course of action. Consider, if the same health insurance plan costs less in Utah than in Florida, why is that? It is because health insurance claims are less in Utah than in Florida. If a ton of Florida residents were to buy the Utah insurance because of its lower relative premiums, in a short time Utah’s claims experience increase because Florida’s health care costs are higher. The Utah policy’s claims rerserve would shrink,(because Utah’s health care claims are lower and the Utah policy’s premiums are based on Utah’s health care costs, not Florida’s health care costs)….end result, premiums for the Utah policy will increase sharply. Better course of action is to allow the marketplace and competition work to reduce premiums in the future.

For now, we must wait to see what is next on the health insurance horizon. Frankly, I hope to see a return to the health insurance marketplace as it existed pre-Obamacare, with the addition of an option for those whose health history barred them from obtaining health insurance in the past. Options could be some form of means tested Medicaid with levels of assistance based on ability to pay. As medicaid is a state/federal partnership, some federal dollars could be block-granted to participating states to help off-set the added costs such a program would create. I also favor the fed’s transferring health insurance matters back to the states where it belongs. Prior to the advent of Obamacare, administration of insurance matters rested with the several states, not with the federal government…see the 10th Amendment.

Carpe Diem

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After January 20, 2017, will we dwell in Obamacare Limbo?

January 20, 2017…a new sheriff in town…what to expect? Well, what not to expect will be immediate rescission of the Patient Protection and Affordable Care Acts of 2010. Doing so would create an earthquake of uncertainty and disruption in the country. Look for congress and the president to take a more measured approach to dismantling Obamacare and its encumbering regulations…something like untangling last year’s string of Christmas tree lights. Oh, and do not believe anything you read in your news paper, see on television, or read on-line, because most of it will be a load of alarmist BS and speculation.

If you have health issues and fear being dumped by your health insurance company, not to worry. The new administration does not intend to throw you under the bus. Instead, expect a safety-net program involving Washington, your home state, and the health insurance industry to assist you.

Common sense would dictate returning the element of risk back to health insurance a’la pre-Obamacare days. Insurance companies’ engineers are their math-major Actuaries who assign dollar cost values to the probability of illness/accidental injury based on sound statistical data. Such data helps set premium requirements to ensure claims can be covered and the insurance company can pay for its overhead costs and return a reasonable profit to its stockholders. Obamacare rules require health insurers to pay out in claims between 80% to 85% of their gross premium income every year, or return to difference to its insureds. In the real world, no company, insurance or otherwise, can survive on 20% to 25% of its gross income. Could you survive on 20% to 25% , of your gross pay check?

Reverting to pre-Obamacare health insurance product pricing would result in more rational premium costs to Joe and Jill six-pack. Average health history would result in average premium costs, better than average health history would result in discounted premium costs, not-so-good health history would mean higher premiums to recognize increased risk. Very significant negative health history could result in a person’s not being able to qualify for health insurance, or being forced to pay much more than the average person for their health insurance…and those are the people Washington and the states intend to offer assistance to in the form of help with paying premiums or admission the a state’s Medicaid program.

Believe it or not, owning Health Insurance is not a right. It is not a right mentioned in the Constitution because the Constitution does not bestow rights. Instead it protects the rights one is born with. One may do without owning health insurance, but doing so does not mean doing without healthcare. If you show up on any hospital’s door step in America, they must treat your condition. That is a federal law.

So, look for Obamacare to go away, but not in a flash. Instead look for a two level approach, with our “uninsurables” being assisted by a combination of federal, state and private sector safety net, with a return of the more traditional health insurance of the pre-Obamacare days.

What is to stop the evil health insurance companies from over-charging Joe and Jane six-pack when they seek health insurance coverage after the demise of Obamacare? Competition and your state insurance regulators, just as it was pre-2010. The Patient Protection and Affordable Care Acts did not protect anybody and it sure as hell did not make health insurance more affordable…just the opposite for several reasons which would require much more space to discuss.

For now stay on top of your members of the House and Senate. There may be a new sheriff in town, but a whole lot of those in the House and Senate who brought you Obamacare are still there and intend to continue pushing our Republic toward socialism….Socialism? Think Germany, France, Venezuela, Greece and other near politically bankrupt countries.

Carpe Diem

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True or False….My Health Insurance Covers Me Everywhere

Answer: It Depends…Read your policy

If your health insurance is a Health Maintenance Organization (HMO) plan, you must secure your healthcare services from that insurance company’s network of health care service providers in your home service area, unless your health problem is a life-threatening emergency situation. HMO members may, or may not, have access to their insurance company’s network of providers when traveling outside their home residence area…read your policy. If you live in city A, travel to city B and wake up one morning feeling punk…coming down with a flu bug, what doc can you call? Your HMO might not cover you in city B, if you are considered “out of area”.

Of course you are free to visit any doc anywhere. It’s your choice. However, you may be forced to pay the doc’s full bill out of pocket if that doc is not in your HMO insurer’s network of contracted healthcare service providers and/or your travels have taken you away from your home area network. Read your policy.

There are HMO plans providing out-of-network benefits, (so-called POS or PPO plans). Typically, such offer one set of benefits when utilizing the insurance company’s network of contracted healthcare service providers and a second set of benefits when such services are provided by non-network providers. You will pay more of the bill when using out-of-network providers but, unlike pure HMO plans, at least some of the bill may be covered.

Due to the effects of the Patient Protection and Affordable Care Acts of 2010 (Obamacare), most health insurance plans available these days are HMO plans, with only a few POS/PPO plans remaining.

Oh yes…don’t forget to Read Your Policy.

Carpe Diem

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Did You Qualify for Obamacare Tax Credit in 2014? You might receive a letter from IRS.

Our favorite civil servants at the IRS are scouring 2014 form 1040’s looking for you scallywags who may have received a larger than appropriate tax credit off-set to your Obamacare monthly premiums. If you received a too generous tax credit, IRS will be on your case to claw back those thousands of dollars in premium relief that you filched from the income tax kitty.

A word to the wise…pull out your 2014 income tax return and make sure you have nothing to worry about…however, if you over-collected on premium tax credits…3…2…1, begin to worry.

Carpe Diem

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Who Feeds Your Family When You Can’t?

The answer to that question is probably local, state or federal relief organizations for a lot of folk…but what about YOU? If you are like most working Joe and Jill Sixpacks, you show up for work every day and collect a salary or wages a couple times each month…or maybe you are self-employed and rely of service or professional fees to support yourself and family. What if an injury or illness makes showing up at work impossible? Who has your back? Not Washington, not your state, and probably not your neighbors down the street…Think about that.

Okay, I’ll concede that if you are injured on the job there are probably limited workers compensation benefits for you if you work for the MAN, but how much and for how long?…and who wants to go to some government office, hat in hand, to ask for help? That has to be your last resort…check your dignity at the door.

However, there is a form of insurance that keeps cash coming in when accident or illness cuts off your ability to earn an income for long periods of time. It has a name, Disability Income Insurance. Ask your insurance agent about it…beats the sox off relying on an EBT card. Disability Income Insurance isn’t cheap, and not everybody can qualify to buy it, but owning some can do wonders for your peace of mind.

Carpe Diem

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