Cone Of Silence

Those of us over the age of 60 are used to receiving an incredible amount of junk mail.  I am, of course, referring to the unrequested, unwanted, and unneeded solicitations from Medicare insurers, call centers, and marketing associations.  Many of these mailings are designed to look like official communications.  We also get unwanted solicitations on our home phones and cells.  And don’t forget the misleading television and radio commercials from the washed up athletes and C List celebrities.  It is hardly surprising that the Centers for Medicare and Medicaid (CMS) receives tens of thousands of complaints each year.  What is surprising are the steps CMS is taking to solve the problems.

Step One:  As per CMS: Agents must provide the following disclosure

• Verbally conveyed within the first minute of a sales call
• Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content)
• Prominently displayed on Third Party Marketing Organization websites (regardless of content)
• Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the Third Party Marketing Organization

Step Two: Recording Telephone Conversations

“Beginning October 1, 2022, for all 2023 activities, all TPMOs, including all third-party marketing/lead generation vendors, agencies, 1099 agents and brokers (captive, independent street brokers, TeleDigital agents, etc.), will be required to record all beneficiary calls (sales, enrollment, administrative, etc.) – inbound and outbound – in their entirety, with no exception. Other important requirements:

• Applies to all telephonic activities, even if it does not result in an enrollment.
• Requirement applies to all beneficiaries and members. There is no distinction made between new and existing clients.
• Consent to record must be obtained for all calls.
• Recordings are not required for in-person activities.
• Medicare requires all records be maintained for 10 years”

In English, we are now required to record ALL telephone conversations that have anything to do with Medicare.  There are no exceptions.  For example, if you live in Billings, Montana and call your local agent on October 2^nd to confirm your October 17^th appointment, the conversation will sound like this:

Bob Smith, Insurance Agent – Thanks for calling Smith Insurance.

Larry Jones, longtime client – Hi Bob.  It’s Larry Jones.  I’m just calling to confirm our appointment for Monday, October 17^th at 11 AM.

Bob Smith – Hi Larry.  Before I can go any further, the government requires me to read the following disclosure to you: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."

Larry Jones – What the Hell does that mean?

Bob Smith – Wait, there’s more.  I need to ask your permission to record this call.

Larry Jones – Why?

Bob Smith – Every Medicare related phone call has to be recorded and kept for ten years.

Larry Jones – You’re kidding!

Bob Smith – I’ve been your agent for over 10 years.  I wish this was a joke. May I have your permission to record this call?

Larry Jones – Fine.  Just do it.

This is going to work as well as the Cone of Silence.

Your local agent is working through this process.  We are researching different recording systems all the while hoping that this rule will be put on hold for a year or two or hopefully twenty. Smart agents already retain copies of all emails and take copious notes during in-person meetings.  Recording phone conversations will complicate our lives and undoubtedly feel like one more intrusion into our client’s privacy, but we will all survive.

As per the disclaimer, HELL YES, WE DON”T REPRESENT JUST ANYONE.  Your local agent is solicited daily by the insurers and marketing organizations.  We each choose which companies we want to represent based on our experience with their service, networks, and product design.  I refuse to represent certain well-known carriers because of issues I’ve had with their service.  Not offering every plan available in the area is not a negative.  Your local agent is proud to represent only the companies he/she selected.

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The doctor is a social acquaintance.  He is not really a friend.  He is not a client.  Doc wanted me to know that we are “just breaking the surface” on COVID.  He used the phrase several times to emphasize how much more there was to know and how little those of us in the general public knew.  As a doctor he was privy to so much more, none of which he planned to share with me, a mere insurance agent.  I’ve known him for a number of years.  This wasn’t the first time I had encountered his demi-god shtick.  Still, I would have been happy to learn any useful information he might have been willing to share.

But I have information, too.  I have a couple of years’ worth of conversations about COVID with my clients.  I know that some of my clients have spent time in the hospital and that, sadly, some have died.  We’ve discussed the lingering effects of long COVID and the question of when/if the individuals will ever fully recover.  And some of my clients have had other non-COVID illnesses that seem to last for months and months.

My clients share their health concerns with me.  We discuss their fears about tests and procedures, the potential costs of hospital stays and the newest drugs.  Another big topic are the doctors who don’t listen to my clients’ concerns and only ask the questions from the pre-printed checklist.  Some of those conversations are with people under age 65 and some are with Medicare beneficiaries.  Most Medicare beneficiaries will refrain from deep, personal conversations once their calls are recorded.  That’s a shame.  Our in-person meetings will just have to be a little longer.

Dave

www.cunixinsurance.com

Picture – Would You Believe A Shoe Phone? – David L Cunix

When The Goal Is Failure

 

The answer was, “NO”.  I hate to say, “No”, and I hate to disappoint a perspective client.  And yes, I hate to fail.  Joseph (name changed) has had a lot of disappointing news lately.  Joe has worked for the same employer for over ten years.  He and his family are covered by the employer’s group health insurance policy.  The employer has always paid a portion of both Joe’s (employee) premium and also part of the family’s (dependent coverage) cost.  Now, as of June 1^st, the employer will only pay part of the employee premium.  Joe is left to pay all of his wife and son’s premium.  The cost is prohibitive.  Here are options we could pursue:

·         Were it not for the Family Glitch, discussed in my last post, we might be able to get a tax credit subsidy to help him pay for his spouse and son’s coverage through healthcare.gov.

·         If Joseph’s spouse and child didn’t have any preexisting conditions, we could move them to short term major medical coverage.  Short term policies are less expensive because they are not guaranteed issue.  The application is underwritten.  You can be declined.  Preexisting conditions are NOT covered.  This is not a good for them.

Joseph and his family can not be without insurance coverage.  He does not want to look for a new job.  They will be forced to cut back and find the money for the premiums for the rest of 2022.  We can only hope that the Biden administration’s plan to fix the Family Glitch will be in place by this year’s Open Enrollment Period that begins November 1^st.  My goal is to view this  as a set-back, not a failure. 

But what if the goal is failure?  What if you have spent the last ten years or so working every day to make it harder, not easier, for Americans to access and pay for health care?  And that brings us to Senator Pat Toomey (R-PA).  You probably don’t think about Senator Toomey when you are thinking about health care legislation.  He has spent most of the last decade decrying the introduction of the Patient Protection and Affordable Care Act (Obamacare), voting for the repeal of the law without any replacement, and still talks about the debunked theory that everything will be fine if we could only purchase health insurance across state lines.  Now in the waning moments of his last term (like Rob Portman (R-OH) he beat the electorate to the punch and chose to not seek re-election), Mr. Toomey has decided to make a last attempt for both relevance and to gain the attention of some future employer.  Mr. Toomey is too committed to the failure of Obamacare to suddenly want to help Americans afford their health care.  Instead, on May 11, 2022 he and fellow consumer advocate, Senator Richard Burr (R-NC) have attacked the Biden administration’s attempt to fix the Family Glitch. 

This is the link to the Toomey / Burr press release.

The opening sentence dispels any possibility that this is a good-faith effort by Senator Toomey to help Americans access and pay for health care.

“This action would further the reach of the federal government into Americans’ daily lives, placing more federal red tape between patients and their doctors.”

Helping American workers pay for their health insurance does not insert the government between the patient and the doctor.  People like Joseph will have a choice.  He will be able to keep his employer’s coverage for his family if he can afford it and if it serves his family’s best interest.  Or, he might be better off purchasing a policy through the government’s exchange, possibly with a tax credit subsidy.  Joseph is not alone.  According to the Kansas Health Institute, a nonprofit, nonpartisan educational organization based in Topeka, approximately “40,000 Kansans are not eligible to receive premium tax credits due to what is known as the ‘family glitch’.”  The Kaiser Family Foundation estimates that over 5 million Americans are affected by this across our country. 

As I noted last month, members of the National Association of Health Underwriters (NAHU) go to Washington every year to fight FOR our clients.  We have asked Congressmen and Senators to address this issue for over 10 years.  We know how the laws passed by Congress and regulated by the various agencies impact our clients.  It is that information that we bring to our elected representatives.  We are so close to making life easier for our clients.  This doesn’t solve everything.  It doesn’t make Obamacare anywhere near perfect, just a little better.  

Our efforts have been focused on helping Joseph and millions of Americans like him.  That was our goal.  Once again we have been reminded that for some, the goal is failure. 

Dave 

www.cunixinsurance.com

Picture – When Failure Is Inevitable – David L Cunix

 

 

 

 

A Glitch Can Be Fixed

It may have been on my first day as an insurance agent.  It could have been the second.  Regardless, this was one of the first and most important lessons I learned about employer-sponsored group health insurance:

The purpose of group insurance is to attract and retain good employees.

Our job as agents was to help the employer find the sweet spot, the package of benefits that was both cost effective and yet appropriate for both the particular industry and job market.  Highly competitive industries offered more comprehensive health insurance coverage.  Some employers felt that even though their competitors offered little or no benefits, they had a moral responsibility to provide health insurance coverage.  Sometimes though, the system prevents this.

November 24, 2014 was The Day We All Lost.  My blog post told the story of Thomas Roberts (name changed) who was forced to cancel his company’s group health insurance policy.  I noted that some of his employees migrated to individual policies and wondered how many would still have coverage four or five months later.  Both Thomas and I were concerned.

It is now seven and a half years later.  Some of Mr. Roberts’ employees retained the individual policies.  Some left his company in search of a job with benefits.  He and I still talk on a regular basis.  He wants to provide group health insurance to his current employees and, of equal importance, he is having difficulty hiring new employees.  Group insurance would help.  I may have some good news for Mr. Roberts, his employees, and millions of other Americans.

The Biden Administration has proposed new rules to fix the Family Glitch.  This is a quick definition of the Family Glitch from an April 2021 Kaiser Family Foundation article:

“Financial assistance to buy health insurance on the Affordable Care Act (ACA) Marketplaces is primarily available for people who cannot get coverage through a public program or their employer. Some exceptions are made, however, including for people whose employer coverage offer is deemed unaffordable or of insufficient value. For example, people can qualify for ACA Marketplace subsidies if their employer requires them to spend more than 9.83% of his household income on the company’s health plan premium.

Currently, this affordability threshold of household income is based on the cost of the employee’s self-only coverage, not the premium required to cover any dependents. In other words, an employee whose contribution for self-only coverage is less than 9.83% of household income is deemed to have an affordable offer, which means that the employee and his or her family members are ineligible for financial assistance on the Marketplace, even if the cost of adding dependents to the employer-sponsored plan would far exceed 9.83% of the family’s income. This definition of “affordable” employer coverage has come to be known as the “family glitch.”

The link in the quote takes you to a KFF August 2011 article.  This is not a new problem.  Members of the National Association of Health Underwriters (NAHU) go to Washington every year to fight FOR our clients.  We have asked Congressmen and Senators to address this issue for over 10 years.  Too many of our elected representatives have been too busy trying to repeal the Patient Protection and Affordable Care Act (Obamacare) to have any time to try to make it work.  The Biden Administration has put forth real effort to make health care more accessible and affordable.  This is just one more step.

What might change?  Let’s go back to Thomas Roberts and his business.  Mr. Roberts’s business is in a highly competitive industry.  Most, but not all, of his employees are unskilled or semi-skilled workers.  He can afford to pay most of his employees’ health insurance premium, perhaps as much as 90%.  He can not afford to pay the premium for their dependents.  Under the current interpretation of the law, the spouses and children would be ineligible for a tax credit subsidy to help to pay their premiums.  Forced to pay the full cost, they are more likely to be uninsured.  Instead, Mr. Roberts will be able to put in to place a group health policy for his current and future employees.  The families will be able to apply for health policies through the Marketplace and if their incomes warrant it, get a tax credit subsidy to help pay the premiums.

The net gain will be more insured Americans.  And we again have confirmation that a glitch can be fixed.  All it takes is someone to care.

DAVE

www.cunixinsurance.com

Picture - Glitch – David L Cunix

Blog-Mitzvah, The Thirteenth Anniversary Of Health Insurance Issues With Dave

Today’s post marks the thirteenth anniversary of Health Insurance Issues With Dave.  Thirteen years and 325 posts.  A surprisingly large number of you have been regular readers for years.  Others, like some agents in Arizona and California, are new to these posts.  I started on BlogSpot and added the WordPress version on my website.  Some of you are reading this on the AOL Patch system and others on Linked In.  Four different locations and four different formats.

At the top of each post are the four guiding principles of this blog:

• PURPOSE Short Articles designed to illuminate different aspects of the health care discussion.
• CORE PREMISE If you think you know all the answers, you probably don't understand all of the questions.
• CENTRAL BELIEF Absolute Power Corrupts Absolutely
• AUDIENCE Our current health care system impacts all Americans.

Some of the articles weren’t quite that short.

My first post focused on an elderly gentleman with multiple health issues who was waiting for a kidney.  Should he get one before a younger, healthier individual?  Should we pay for this through Medicare?  Who decides?  The post then notes:

The payment and delivery of health care in the United States must change. There is too much pressure, political and financial, for Congress to ignore. This is good. Our current system is a hodgepodge of stop-gap measures masquerading as a solution. Unfortunately, some of the most vocal proponents of change have some of the most unrealistic answers to this question. We can not have unfettered access to any and all care without restriction or cost.

Since then I interviewed hospital administrators, elected representatives and their staffs, and had a couple of guest posts.  I have analyzed both the Democratic proposals and the Patient Protection and Affordable Care Act as well as the Republican proposals.  And when our entire system was under attack by either the State of Texas or the White House, I didn’t shy away from detailing exactly how we would all be impacted by their blatant disregard for our access to health care.  Though a Centrist Democrat, I have ticked off Democrats and Republicans equally.  The truth, as I saw it, was my goal.  I hope that I have come close.

I’ve had a lot of fun doing this.  When the editors of the local AOL Patch came to my office and asked for me to post on their then 17 local publications, they said that I needed to have a picture.  The pictures were a new element and a challenge.  I hope that you have enjoyed some of them.  The links are often my favorite part of each blog.

It was important to me that this blog was more than just my opinion.  The links are what made the difference.  It wasn’t enough to cite a law or a court case.  The blog linked you to the actual document.  And when the Supreme Court weighed in, you were linked to both the decision and to SCOTUS Blog, the definitive analysis of each decision.  Details.  The internet and cable TV are filled with opinions.  It was my goal to provide enough information that you could, if you wanted, read the source material and form your own opinions.

And speaking of fun, some of my readers search the blogs for the links to the songs.  Every blog has at least one.  Always topical and often of a live performance, the music allowed me to add a bit of levity to some very serious posts.  Some politicians even had their own theme songs.

I never imagined doing this for thirteen years.  Thank you for indulging me.  Thank you to the attorneys, financial planners, CPA’s, and bankers who have forwarded this blog to their clients in an effort to explain our health insurance system.  Thank you to the insurance agents around the country who use this blog as a resource and are kind enough to let me know.   And thank you, all of you, who take the time to email me your thoughts.  It is the feedback that lets me know that I’m not talking to myself.

One of our traditions is to make a donation to a charity in honor of a young man becoming a Bar Mitzvah.  Should you be so inclined, please consider your local food bank.

Dave

www.cunixinsurance.com

Picture – The Proud Parent – David L Cunix