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Are your clients good healthcare consumers?

As deductibles and out-of-pocket limits continue to rise, and more and more plans drop the up-front copayments our clients have grown to love, we’re once again hearing the word “consumerism” as a possible answer to America’s health care crisis. The idea behind consumerism is that people purchase health insurance for the big, unexpected medical expenses that may arise and budget for everything else. When people spend their own money, they make different and better decisions than when they’re spending the insurance company’s money. Since they’re not shielded from the cost of health care services, they make buying decisions based on cost and quality—the same way they do in other areas of the economy.

Whether people are ready to embrace consumerism or not, they’re sort of being pushed into it. These days, most of our clients have a “consumer-driven” plan design, even though they may not realize it.

Analyzing the CBO Score: Will 23 Million Really Lose Coverage Under the AHCA?

It’s well-known and generally accepted that the non-partisan Congressional Budget Office is, in fact, non-partisan. The CBO, as you probably know, is the government agency charged with “scoring” proposed legislation to determine its intended and unintended impact. But just because people on both sides of the aisle agree that the CBO’s analyses aren’t politically motivated doesn’t mean that they necessarily agree with their findings.

Take the American Health Care Act, which was passed by the Republican-led House of Representatives on May 4, 2017, without an up-to-date CBO score. The Congressional Budget Office had reviewed a previous version of the bill but had not yet issued its findings about the revised version before the vote, causing opponents to point out that Republicans had passed the bill without even knowing how much it will cost or how many people will lose insurance as a result.

What Agents Do Matters – Part 3

In part 1 of this series, the author explained how some fortunate timing helped his uncle fight cancer without high premiums or big out of pocket expenses. In part 2 of the story, he explained how a cancer policy helped his uncle replace his lost income while he was out of work. In part 3, he discusses his uncle’s latest ordeal and explains why people should purchase insurance before they have a need.

I started this story by talking about how my uncle got health insurance. Though he had some pre-existing conditions and neglected medical issues, my uncle was able to take advantage of the health law’s guaranteed issue provision and open enrollment period and sign up for coverage just in the nick of time, right before being diagnosed with cancer.

As we all know, though, that’s not the way other types of insurance work. Most lines of coverage are not guaranteed issue and don’t have an annual enrollment period; instead, people must have the foresight to purchase them ahead of time, before they have a claim to file. That’s exactly what my uncle did when he purchased the cancer policy back in 1996, and it saved him nearly 20 years later. He also purchased an accident plan that he’s never had to use, but that’s a good thing: we purchase insurance not because we have an immediate need but rather because we don’t know whether we’ll need it or not; our hope is that we won’t.

What Agents Do Matters – Part 2

In part 1 of this series, the author explained how some fortunate timing helped his uncle fight cancer without high premiums or big out of pocket expenses. In part 2 of the story, he explains how his uncle dealt with the time off of work.

For years, my uncle had bad knees and always knew that he should have surgery, but he never did because, even if he had had health insurance, which he didn’t, he couldn’t afford to miss work. His social security payments, which began when he was 62, weren’t enough to pay his mortgage, much less the rest of his monthly bills. He didn’t have a huge nest egg and relied on his self-employment income to get by.

What Agents Do Matters – Part 1

This post is being submitted on behalf of a friend of America’s Health Care Plans. He knows we work with thousands of agents who collectively sell insurance to hundreds of thousands of households. He hopes his family’s story will inspire some of you to sell even more because the advice and guidance you provide really does matter.

I grew up idolizing my uncle. He was single, never married, had long hair, and, though he never rode a motorcycle, had a “biker look.” He was, in a word, cool. He did whatever he wanted in life and always had the best stories, mostly tales from being a teen in the 60s. He was happy and never seemed stressed. I remember him telling me that he didn’t gamble because he always lost, but that was ok—he was unlucky in gambling but lucky in life. Things always seemed to work out for him, and that proves true in his recent health insurance experience.

The Trump Administration’s Market Stabilization Rules

With the failure of the American Health Care Act—the House Republicans’ first attempt at repealing and replacing Obamacare—there will be more pressure on federal regulators like HHS Secretary Tom Price to “do something” to increase competition, expand plan options, and keep prices under control.

The Affordable Care Act delegated much of the responsibility for implementing the health reform legislation to government agencies like Health and Human Services, the Department of Labor, and the IRS. For the first three or four years after the ACA was signed into law, we eagerly awaited proposed and final rules on everything from the individual mandate and premium tax credits to market reforms and the employer shared responsibility requirement. Once we knew the rules, we could properly advise our clients and recommend solutions to help them comply with and, in some cases, get around the regulations.

What to tell your clients about telehealth

To help combat the rising costs of health care we’re seeing a lot of new consumer tools emerge and growing in popularity.  Services and tools such as telemedicine, healthcare pricing tools, and prescription discount cards.  Some are offered on a stand-alone basis; others are incorporated into the health plans you’re already selling. Because these services are growing in popularity, we thought it was time for a quick update. In this post, we’ll get you up to speed on telehealth.

While there are variations among different telehealth providers, what these services do is give members the ability to visit with a doctor by phone or video conference and receive advice and some prescriptions, if medically necessary. The telehealth company works with a number of family doctors who take the calls and review the members’ symptoms, as long as the symptoms described are minor, the doctors are able to diagnose over the phone. Some of these physicians have their own practices and take calls between seeing patients; others work for the telehealth companies.


The American Health Care Act had only a 17% approval rating before being pulled without a vote on Friday, March 24. The legislation would have made a number of positive changes for Health Savings Accounts, but the good news for HSA fans is that Republican lawmakers have another shot at expanding these popular tax-advantaged accounts.

On February 15, the Health Savings Act of 2017 was introduced by Senators Orrin Hatch (R-UT) Representative Erik Paulsen (R-MN). This bill would make many of the same changes that were proposed in the American Health Care Act plus a whole lot more.

The Individual Mandate’s Tax Filing Requirements

As we approach the end of tax season, there’s a lot of confusion about the tax filing requirements under the Affordable Care Act’s individual mandate, largely because Americans have received mixed messages about what the rules actually are.

On day one of his administration, for example, President Trump signed an executive order instructing federal regulators to take steps to ease the financial burdens of Obamacare, and the IRS responded by saying that the agency would not automatically reject 2016 tax returns that fail to answer the question about whether the individual or family had minimum essential coverage. We’ve also heard Republican lawmakers on cable news stations saying that they will soon be repealing Obamacare and eliminating the individual mandate. In the American Health Care Act, they tried to do just that: the AHCA would have reduced the ACA’s individual shared responsibility penalties to $0 beginning January 1, 2016.

The American Health Care Act – What Now??

On Friday, March 24, President Donald Trump and Speaker Paul Ryan made the decision to pull the American Health Care Act—the reconciliation bill that was designed to repeal sections of the Affordable Care Act—after it became obvious they didn’t have the votes to send the proposed legislation to the United States Senate. The House Freedom Caucus, a group of about three dozen highly conservative Republican lawmakers, is being blamed for the bill’s failure as the majority of its members refused to support the legislation. Their argument was that they had promised their constituents they would repeal and replace Obamacare but the Ryan plan stopped short of accomplishing that goal; instead, they referred to the bill as “Obamacare-lite” since many of the law’s provisions would remain.

Before deciding to walk away from the deal, President Trump visited with Freedom Caucus members, made some concessions, and then met with more moderate Republican lawmakers who were unhappy with the changes. In the end, it was clear that the party wasn’t united behind the bill, so instead of putting lawmakers on record with a vote for or against the unpopular proposal, President Trump agreed with Paul Ryan that it was better to withdraw the bill.

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