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New Hospital Transparency Rule

A new rule intended to increase price transparency went into effect January 1st of this year. The rule, issued by the Centers for Medicare and Medicaid Services (CMS) on August 2, 2018, requires “hospitals to make publicly available a list of their standard charges or their policies for allowing the public to view this list upon request…on the Internet in a machine-readable format.”

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Drug Makers Increase Prices for 2019

In 2019, some of the nation’s largest pharmaceutical companies, after holding prices steady for much of 2018, announced they are raising the cost on hundreds of drugs. You probably saw some of the headlines.

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New Rule Could Increase Premiums and Out-of-Pockets

The Wall Street Journal recently reported on proposed changes by the Trump Administration “that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act.” As they explain, the two sides continue to bicker about the Affordable Care Act: “Republicans say subsidies for consumers are inflated; Democrats see another effort to sabotage the health law.”

The proposed changes they are referring to are found in the Notice of Benefit and Payment Parameters for 2020. This is an annual notice released by the Centers for Medicare and Medicaid Services (CMS) that sets the standards for issuers and exchanges for the coming year.

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Healthcare.gov Enrollment Numbers

Marketplace enrollment is down this year. Way down. At least that’s the conclusion one might reach by looking at the enrollment trend graph on the Kaiser Family Foundation website.

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Medicare Changes for 2019

Each year, Medicare makes changes to the Part A and B out-of-pocket expenses, monthly premium for Part B, and premium adjustment thresholds for Part B and Part D. Here are the figures for 2019.

Cost Sharing

Medicare Part A requires beneficiaries to pay a portion of the cost of hospital and skilled nursing stays.

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Are you teaching your kids the business?

Most of us didn’t grow up wanting to be insurance agents. Instead, the majority of insurance professionals found their way into the business by accident. There are a million stories, but what we’ve heard again and again from brokers across the country is that 1) they sort of stumbled into the industry, 2) now that they’re here, they really like it and don’t want to leave, and 3) they wish they had started when they were younger.

That brings up an interesting question: are you teaching your kids the business? And if not, why not?

There are all sorts of things that make health insurance an excellent career choice.

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Don’t Give Clients Options, Give Them Guidance

There’s been a trend in the insurance industry over the past few years. Brokers across the country have invested in technology that allows them to quickly and easily provide quotes to clients in an “apples to apples” format so that the client can make a buying decision, often without any additional input from the agent. Many agents even have quote engines on their website that allow clients to run the quotes and apply for coverage on their own without ever talking with the broker. With today’s tools, brokers can literally sell insurance in their sleep.

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On January 5 of last year, we published an article about the proposed merger between CVS Health and Aetna. One year later, the acquisition of Aetna by CVS has been finalized and the two companies are now one.

Clearly, this deal was different than the big Aetna/Humana and Anthem/Cigna mergers that ended up falling through a couple years ago. In both of those proposed deals, two insurance giants would have joined forces, which is part of the reason the Department of Justice intervened. Federal officials were worried about reducing competition and limiting consumer choice.

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A Creative Way to get Individual Clients

One thing we learned from the 2019 open enrollment period is that the government’s outreach efforts are coming up short. Marketplace enrollment was down this year, and that corresponds with a huge 90 percent reduction in the marketing budget for Healthcare.gov.

For agents, that’s actually a good thing. If it were as simple as taking orders, the government and the insurance companies wouldn’t need us. In our current system, though, many people will go without coverage unless an agent shows them their options and explains the importance of having health insurance.

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Understanding Facility Copayments

Most of us understand what a copayment is, right? It’s a fixed dollar amount that the insured pays for certain covered services on a health plan before benefits are paid by the plan. Usually, but not always, benefits that apply these copayments, or copays for short, are paid before the calendar-year deductible has been met and after the copay has been paid by the insured. Some HSA-qualified plans, though, do have copayments for prescriptions that kick in after the deductible has been met.

When discussing how their health plan works with our clients, the conversation might go something like this.

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