Open Enrollment For Medicare Is Just Around The Corner

October 15

October 15th marks the beginning of Medicare’s open enrollment process for Medicare Advantage plans like Coventry Advantra, Humana and UnitedHealthcare AARP.  This open enrollment period also applies to Part D stand-alone prescription drug programs.

Open enrollment lasts from October 15th through December 7th and is the only time you can enroll in these programs or make a change between Medicare Advantage plans or Part D insurance carriers unless you have a qualifying event.  In order to be eligible for enrollment to any of the plans, you must have your Part B Medicare enrollment completed.

Many of the Medicare Advantage plans are low cost or zero premium plans, but they do operate under the network provider system and may not be suitable for all Medicare recipients.  For example, if you live in the Midwest but spend your winters in Arizona or Florida, you may not have network access to providers when you are out of your provider network.  In this case, a MediGap or Medicare Supplement plan like Blue Cross and Blue Shield, Stonebridge or Mutual of Omaha may be a better choice, providing you access to doctors, hospitals and clinics anywhere in the country that accept Medicare.

Choosing a Medicare Advantage or Medicare Supplement plan should be done with the help of a licensed, certified broker or agent so you know (before you make your choice) what your options are, what the restrictions are and what monetary obligations you will have for out-of-pocket expenses.

It is important to note that using a broker when choosing a plan does not cost you anything and does not change the price of that Medicare Advantage or Supplement plan.  Additionally, if you have claims problems or provider problems after the policy is written, it is the agent or broker’s responsibility to interact with the carrier on your behalf as your advocate.

Plan ahead, choose wisely and you will probably find the Medicare products much more affordable than conventional healthcare policies while still providing the same level of benefits.

Cary Hall

America’s Healthcare Advocate

New ObamaCare Insured Not Understanding Health Insurance: Who’s On First?

A recent article in The New York Times states Americans who signed up for ObamaCare find their policies complicated and have difficulty understanding them.

To quote Resources for Human Development program coordinator Rebecca Cashman, “It’s not like you enroll and, voila, you immediately know how to use it.”  Actually, if Ms. Cashman’s program members had used an exchange-certified broker or agent, then, voila, they would have understood how to use their policies.  Ms. Cashman went on to say, “There are a lot of people who really have some big questions about ‘what now?’”

Exchange certified agents go through more than ten hours of training and testing in an effort to make sure they understand the exchange rules, subsidies and policies.   The National Association of Health Underwriters certifies agents and has an Agent Finder tool on its website to help consumers in finding qualified brokers and agents to assist them in qualifying for subsidies and purchasing health insurance.

Ms. Salwa Shabazz who is epileptic stated she didn’t understand the plan when she chose it and that her doctors were not in her plan.  She states, “None of that was explained when I signed up.”   Once again, had Ms. Shabazz been counseled by a certified broker or agent, she would have clearly understood that she had purchased a plan with a narrow provider network and would have known that her doctors were not included.

To solve this problem, the Centers for Medicare and Medicaid Services is launching a new project named “From Coverage to Care.”  What’s fascinating about this effort along with The New York Times article is that not once are brokers or agents referred to anywhere as a free resource for consumers who would solve 90 percent of the problems people face in understanding the health insurance process.

We don’t need another government program.  We do need the government to stop stonewalling brokers and agents and to recommend us as a resource for assisting consumers in the purchase of health insurance as we have done in my agency for the last 16 years.

Cary Hall

America’s Healthcare Advocate

Could A Lawyer in Greenville, South Carolina Have the Silver Bullet That Kills ObamaCare?

A bearded, be speckled avid gardener and father of three grown children is the relatively obscure figure behind the litigation of Halbig v. BurwellThe attorney, Mr. Christina, with the law firm Ogletree Deakins was the catalyst behind the lawsuit that latched onto the wording which caused the DC Circuit Court of Appeals to rule that only state funded exchanges could have subsidies.

In another ruling in the Fourth Circuit Court of Appeals, King v. Burwell, this appeals court ruled that the subsidies are indeed legal for people purchasing insurance on the federal exchange and are not limited to state run exchanges.

Although the wording in the Patient Protection and Affordable Care Act explicitly says only state run exchange participants can receive federal tax credits for their health insurance, we now see two different opinions (one for and one against) by the federal appeals courts.

Since the Obama administration has requested an en banc review by the DC Circuit (meaning all 11 members would have to rule on this case and its wording vs. the 3 who originally ruled), the Obama administration may find itself going back to the Supreme Court as a result of these two opposing decisions and the en banc ruling request.  The losing lead litigator in the 4th Circuit decision, Michael Garvin of Jones Day can now petition the Supreme Court for an expedited appeal which would throw the whole case back to the Supremes for a second ruling, meaning Chief Justice Roberts would have a second bite at the apple on whether or not he will uphold ObamaCare again as he did in his first ruling.

While all of this makes for great theater and speculation, it leaves the insurance industry in turmoil and one wonders what would happen if the Supreme Court ruled like the DC Circuit regarding the language striking down subsidies on the federal exchange.

Just when you thought it was safe to go back in the water again, it appears the sharks could be circling for one last bite that could be fatal to ObamaCare.

Cary Hall,

America’s Healthcare Advocate

One-Size-Fits-All Medical Care Will Soon Be A Thing of the Past


If you were born in 1889, your average life expectancy (for a man or a woman) was about your mid 40’s.  Today, that life expectancy is nearly age 80, with many people living well into their 90’s and more and more making it past the 100 year mark.   It’s amazing how the field of medicine has changed in the last 125 years, more impressively how quickly it has changed in the last 25 years.

In the future, we can expect to see even greater changes and the specific tailoring of each person’s medical care under his or her own unique genetic makeup. The cost of sequencing a person’s DNA is now only $1,000 dollars. That’s amazing when you consider the cost to produce the first sequence of human genome about 10 years ago was $400 million dollars.

What can we expect?  DNA sequencers will analyze our microbiomes and how these microbiomes affect individuals with regard to obesity, cardiovascular disease and other treatments.  They also hold the key to the future on cancer treatment which we already see in place with providers like the Cancer Treatment Centers of America (we will be featuring Dr. Laurence Altshuler of Cancer Treatment Centers of America on our broadcast this weekend).

These new treatments will enlist a patient’s own immune system to fight the disease, building cellular ninja warriors to take out cancer tumors.  We will also see genome research revolutionize treatment for Alzheimer’s disease, autism, depression, Parkinson’ disease, stroke, epilepsy and many other neurological disorders.

If you read the Bible’s Old Testament, you know it’s not unusual to see stories of individuals like Job and Enoch who lived to be over 200 and 300 years of age.  It wasn’t so long ago that people found these ages hard to believe.  Now it seems it won’t be too long until we may see that kind of life expectancy again.

Cary Hall

America’s Healthcare Advocate

A July 4th Look at the State of the Presidency


On this most patriotic of national holidays, July 4th weekend, I thought it would be appropriate to take a look at the state of our nation and most particularly how President Obama is viewed by the American public.

With the American economy contracting by 2.9 percent in the first quarter of 2014 and the Supreme Court slapping the president down in 4 rulings over the past two weeks, The Wall Street Journal reports that the most recent Gallup poll shows confidence in President Obama at an all-time low of 29 percent.

It’s not hard to understand why his approval numbers are so low when you look at issues like the IRS scandal in which a June 4th Fox News poll shows 76 percent of the public believes the IRS deliberately destroyed emails as part of a cover-up.

A recent Newsmax poll goes on to show that 79 percent of those polled do not trust the president and 65 percent of the people believe the president’s signature healthcare law (ObamaCare) has hurt them and not helped them.

In the face of all this we see a defiant president taunting the House Majority Leader John Boehner to sue him.  Who would have predicted when he took office that President Obama’s numbers with 2 years left on his term are matching those of George W. Bush’s?

While liberals and progressives surely must be disappointed in how their president is perceived and the failure of his ability to get meaningful legislation of any kind passed since ObamaCare, this is no time for republicans and conservatives to gloat over Mr. Obama’s demise since none of this is good for the country as demonstrated by the negative 2.9 percent growth of the economy in the first quarter of 2014.

America is a great nation and we should look to the future with hope and confidence, but that is hard to envision given the political divisiveness that this president has sown.

Cary Hall

America’s Healthcare Advocate


The Next Big Thing for Employers from ObamaCare

The Patient Protection And Affordable Care Act (ObamaCare) requires all group health insurance plans with 100 lives or less to be part of the community ratings system.

Let me take a moment to explain how community rating works.  Let’s pretend that your automobile insurance is community rated.  Your next door neighbor and you share the same insurance carrier (i.e. All State).  However, your next door neighbor has a serious accident, totals his car and a month later is picked up for DUI.  Due to his irresponsible behavior, his new premium shoots up 57 percent.  Under community rating, you also get to share that increase as a result of his actions.

This is exactly how community rating will work for employers with group health insurance plans of 100 lives or less.  So, an employer with healthy employees who has a proactive wellness program in place will now be paying the same rates as an employer with a sicker workforce who does nothing to improve the overall health of his or her group.  And, if there are catastrophic claims, those claims will impact both companies’ health insurance premiums.

In the past, the rating differential was 11:1 or 8:1, meaning carriers could rate groups based on their health and claims experience.  ObamaCare throws that system out and lumps everybody into one category.  The result will be higher premiums for everyone and fewer plan options.  Additionally, if you happen to have a group larger than 100 lives, while you won’t be directly affected by community rating, you will be indirectly affected as the rising costs of small group health insurance impact the overall pool of employer-sponsored plans with specific carriers.

What’s the solution?  Moving to a captive, partially self-funded plan eliminates the community rating requirement and stabilizes premiums by making smaller employers part of a much larger group that functions more efficiently and acts as a shock absorber to catastrophic claims.

Cary Hall

America’s Healthcare Advocate

ObamaCare Bronze and Silver Plans Get Expanded Provider Networks

One of the unintended consequences of ObmaCare’s health insurance on the exchange was the narrow networks with limited access to providers, representing 69 percent of the bronze and silver plans offered.

According to The Wall Street Journal, “ a new analysis by McKinsey & Co. found that 48% of the networks in exchange plans nationwide have limited networks, which means plans with 70% or fewer of local hospitals participating as well as the tiered plans that have higher co-pays to use certain hospitals.”

Plans with these narrow networks and premiums were approximately 17 percent cheaper than others; however, many consumers weren’t aware of this when they purchased the plans based on price only.  This trend is now changing with the biggest providers (WellPoint Inc.’s Anthem Blue Cross, Blue Cross and Blue Shield of California and Health Net) expanding their networks and, in many cases, doubling the number of hospitals available to policyholders.

While many have blamed the insurance carriers for creating plans with narrow networks, this problem actually rests with the providers who refused to accept the ObamaCare reimbursement rate mandated by the new legislation.   It certainly makes one wonder (if they knew then what they know now), would hospitals and health care providers have been making those rose garden appearances endorsing ObamaCare with the President when the legislation was passed?

So, while insurance carriers have to deal with the complaints (and, in the case of one Blue Shield of California plan, a class-action lawsuit by a California law firm), the real cause of the issue is one of the many unintended consequences of ObamaCare.

Cary Hall

America’s Healthcare Advocate

Bring Back the Single-Payer Option

In a recent article in Forbes magazine, one of the panelists in the discussion suggested that the solution to the disastrous roll-out and implementation of ObamaCare would be to bring in the single-payer option; in other words, a government-run health care system.

Guess what?  We already have one.  It’s called the VA Health System, and I’m a card-carrying member.  Recent revelations show just how competent and efficient this government-run health care system is.

The senator from Vermont, Bernie Sanders, noted that while there are problems with the system, veterans are satisfied with their excellent health care from the VA.  Tell that to the approximately 60 veterans who are thought to have died as a result of lack of treatment from the VA and to the 121,000 veterans waiting over 90 days (64,000 of these 121,000 vets appear to have fallen through the cracks after requesting appointments) to get an appointment to see a primary care provider—all of which demonstrates how inefficient and poorly run the VA system is.

But here’s the good news:  VA bureaucrats, protected by their government union jobs, were receiving bonuses while veterans weren’t receiving care and being delayed for surgical procedures up to two years.

So with 57.3 billion dollars in the VA budget (which is a 106 percent increase while patients have only increased 30 percent), the VA will now spend an additional 236 million dollars for 27 new medical facilities and throw 500 million dollars at hiring new doctors and nurses.

As The Wall Street Journal so aptly put it, in the world of government, when you fail, you get more money.  Then everyone expresses outrage and surprise when we get more failure.

So by all means, let’s bring on the single-payer system and let everybody enjoy the experience that veterans have enjoyed with the VA system.

Cary Hall

America’s Healthcare Advocate

Moving Your Employees Off Group Insurance Could Cost You $36,500 A Year

New ObamaCare rules just handed down by the IRS could make you the target of a $100 dollars a day fine ($36,500 yearly).

This obscure new ObamaCare regulation and fine was released by the IRS two weeks ago and basically says if you collapse your health insurance plan and move your employees to the exchange and the IRS determines it was done intentionally to eliminate group coverage, you could be subject to the $36,500 penalty.

Quoting President Obama regarding the reason for this regulation, “ I don’t think that an employer-based system is going to be, or should be, replaced anytime soon.”  The fear of the Obama Administration is that employers will dump their group policies and try to move their employees to the exchange.

A critical part of this ruling forbids employees from using remuneration by employers for the purpose of purchasing health insurance either on the exchange or in the open marketplace, debunking the idea that you could add $350 or $400 to your employee’s paycheck and they could then go and buy a health insurance policy on or off the exchange.

It’s imperative to note that the IRS will be looking to make examples out of employers who make the mistake of shutting down their health insurance policies and dumping their employees into exchange or non-exchange policies.

Richard K Lindquist, the president of Zane Benefits says, “The I.R.S. is going out of its way to keep employers in the group insurance market and to reduce the incentives for them to drop coverage.”

Cary Hall

America’s Healthcare Advocate

Fully Insured Policies Will Now Limit Cancer Care


WellPoint (an independent licensee of the Blue Cross and Blue Shield Association) has announced its policy holders will now be subject to a new protocol regarding cancer care in an effort to lower costs for those seeking treatment of cancer.

Their physicians will be paid a bonus of $350 dollars per month for each patient who is on one of the insurer’s recommended regimens.  In other words, patients are going to be treated according to the insurance carrier’s protocol.

Putting this in perspective, Brian J. Bolwell, chairman of the renowned Cleveland Clinic’s Taussig Cancer Institute said, “We generally don’t like to practice by insurance company, we practice by patient.”

WellPoint estimates that it will save around $216,000,000 million dollars.  The protocols will focus on breast, lung and colorectal cancer but will eventually expand to other forms of the disease.

Roy Herbst, a professor at Yale School of Medicine worries that the “broader push toward a narrower number of regimens might cut against emerging approaches that personalize treatment based on genetic factors.”

It is anticipated that Cigna and UnitedHealth will follow suit with the same protocols.  It is important to note that WellPoint expects its recommendations to apply to 80 to 90 percent of its patients.  What’s important to note here is that these protocols DO NOT apply to self-funded, partially self-funded or captive plans like the ones we offer to our clients.  

Cary Hall

America’s Healthcare Advocate