New Health Insurance Changes for Patients & Providers - MOROF 10/26/17 Presentation
Table of Contents
- Today we've got an interesting topic in regards to insurance and you know if you...
- You don't pay extra for it you just pay discounted prices for your prescriptions...
- Period October 15th to December 7th except for special circumstances you...
- Individuals we're having a conversation about groups so the idea is not that...
- Return so all of its going to get adjusted at the end of the year now...
- Taken his Medicare every now and then Martin Marietta wants to call him up...
00:02
today we've got an interesting topic in
regards to insurance and you know if you
ever wondered if more off really has
their finger on the pulse of what's
going on in health care
we've had several presentations this
year where we have planned the topic and
literally within a week to two weeks
prior to the presentation rulings come
down laws get changed whatever and it
makes the topic so timely and that is
00:36
definitely the case of what we have in
our conversations today about health
care and insurance and all the changes
that are happening that are going to
affect the obviously the medical
practices the the doctors and also the
patient's which you know no matter who
you are if you're live and breathing
you're in one of those categories so
it's definitely going to impact and
affect you with all the different new
regulation that just came down the pipe
within the last two weeks so I know our
speakers have been kind of scrambling to
01:07
update their presentations and to make
things change and affected in that
regard and we've had a few other
presentations this year where it's had
similar type of impact like when we did
a presentation on a DEA compliance for
your website and such and like a week
before the event there's a big ruling
that came down federally saying you know
winn-dixie you are being you know
charged you have to make your website a
DA compliant so so it's really
interesting to see how much more off
really does have a pulse on what's going
on so without any further ado I am going
to introduce our two speakers that we
01:39
have and Craig is going to be speaking
first and then Mitchell both of which
are involved with more up so you might
be kind of familiar with them but Craig
Rodriguez is a UCF grad and he has been
with his insurance company for business
for over 25 years
but really what qualifies him to be
speaking is that he has been involved in
the insurance discussions planning
02:10
government and business issues and he
appears as a topic speaker for business
and entrepreneurial meetings
conventions he testified it for the
Florida Department of Insurance serves
as the Advisory Council for AB med
health plans serves as committee chair
for National Association of Insurance
and Financial Advisors and is regularly
recognized as a top contributing agent
by major insurance carriers for many
client needs and all those who are
things so he's really been involved all
along his career in the legislative part
02:40
of things and and a great adviser so we
have a great resource that can really
tap into what's going on today and where
we best guess things are going to go
down the road for the future the other
speaker is Mitchell Gordon he has a
marketing degree from Nassau College in
New York he's been in Central Florida
for 47 years he owns Gordon he owned a
contracting company for many years he
owned a marketing company now he's doing
Gordon Insurance Group for the past 19
years and really specializes in Medicare
03:13
for the last 7 years and while there may
not be as many changes that are
impacting Medicare and and those things
there there are always a few things that
change in that regard so let's give a
warm warm welcome to Mitch and Craig and
actually Mitchell's going first as our
understanding so yep we're gonna let
Mitchell get a apologize to those who
have heard me speak in the last three
weeks because it's annual election
period because a lot of its going to be
the same but I'm gonna mostly speak on
compliance issues and the rules and
03:49
regulations which are very strict the
first to start off with health care is a
service health insurance is a product
just so you understand okay Medicare as
you met has four parts it's part a b c
and d part aid deals with the hospitals
part b deals with the doctors part c
deals with the replacement plans that
replace medicare the government subs out
the care and that way there's an
04:20
insurance company taking care of you and
Part D our prescriptions now healthcare
when it comes to Medicare the government
is
not supplying you the health care with
the hospitals that you pay a deductible
that doesn't change very often there
have been very few legislative or legal
changes in the last few years in
Medicare for those of us who have
Medicare we're pretty safe with where
the program is the magic number I hear
all the time is 55 so when they make
04:51
stop making drastic changes if you're
under 55 you're gonna get hit with them
if you're over 55 you're gonna be able
to use the same plans that they have now
in the same programs the basic changes
in Medicare itself are just the prices
the prices go up for Part A and for Part
B Part A has a deductible you turn 65
you don't pay for it
you've worked ten years forty quarters
and you're entitled to Part A by the way
90% of what I tell you there'll be an
05:21
exception to each one of them you can
buy Part A outrageously expensive if
you've only been working for a few years
Part B is optional the government's
definition of optional means you don't
have to take it if you don't we're gonna
penalize you 10% a year so if you wait
till you're 70 and don't take it you're
gonna pay a hundred and fifty percent of
what normally you would have paid here's
the exception if you are already insured
and have creditable coverage which means
05:52
you are covered by a company plan or a
private plan that you're able to keep
past 65 which is usually group or in
retirement and it equals Medicare or
better you have creditable coverage you
do not have to take your Part B and
there's a special reason not to and I'll
explain that later again if you have
creditable coverage you make sure you
get something written from your company
that's creditable for medical and
prescriptions because there are
06:23
different parts of the plan a skip Part
C for now and get into Part D Part D is
also same rule it's optional you're 65
you're healthy
I don't need prescriptions I don't need
to take it well the government will
penalize you 1% a month I know people
that are above a hundred percent
up to a hundred and four eight percent
penalties because they never took it so
even if you're not taking prescriptions
you might want that to have Part D I
wrote a couple of notes because the
06:54
numbers change part a has about a
thirteen hundred dollar deductible right
now they won't even tell us what the
change is going to be until about
December January Part B has a premium of
a hundred and thirty four dollars it's
going to be next year this year for some
people it's one hundred and twenty one
for some people is one hundred and
twelve it varies depending upon when you
got into the program when you got your
Social Security and again how much money
you make if you're making a lot of money
07:24
they'll start charging you more okay but
this is also a deductible for Part B so
when you go to the doctors you pay a
deductible about one hundred and eighty
three dollars this year that also may
change so just like Social Security was
just meant to help you it wasn't meant
to support you you had your pensions and
you had your savings and Social Security
that gave you a nice retirement I truly
believe Medicare is the same thing
Medicare wasn't made to cover everything
that you you need it was made to help
07:55
and support you with all the other
things that you have so when you get
Medicare and in seven years and over 300
clients have only met one person that
only has Medicare and only wanted
Medicare there are two directions to go
in and by the way it's also Medicare
isn't as complicated as you think it is
if you take someone out for lunch and
you charge it off on your taxes you
don't have to know the whole tax code I
don't think accounts know the entire tax
code what is it a million pages well
same thing with Medicare you don't have
08:26
to know the whole system you just have
to know where to fix you and how to use
it so Medicare has two directions to go
in you can get the Part C which is a
replacement plan or you can get a
supplement and very simply the
replacement plans the government subs
out to an insurance company just like
when you build your house your general
contractor subs out the drywall all the
electrical the plumbing will the
government sub contracts out to all the
different companies your medical care
they pay them
08:56
dollars let's say $1,000 a months you
don't go to the doctor the company just
made $1,000
god forbid you get cancer and it cost a
million dollars that company's gonna pay
the million dollars you don't lose your
Medicare you just put the card in a safe
place in your house and now you're
covered by a company the advantage to
the Advantage plans are really good zero
premiums for 99 percent of the plans I
present in Central Florida all over the
state actually I work zero copay to go
see your primary care doctor now that's
09:27
great because if you want to there are
people that go to the doctor like three
times a month
very low copay to go see specialists low
co-pays to go to the hospital might be
anywhere from 150 to 300 dollars a day
but only for the first four or five days
or eight days and then after that for
the whole year it's zero so you can be
in the hospital for 60 days and not pay
more than $1,600 that's a great
advantage the disadvantages are your
networked you have to stay in-network
09:58
unless you get a PPO PPO allows you to
go out of network surprisingly here's
the secret about PPO is that you've got
to understand the doctor you go to has
to accept the assignment price from the
insurance company if they don't the PPO
becomes worthless and you have to pay
the doctor the full price so either way
whatever doctor you go to has to accept
assignment price from Medicare so those
that's the disadvantage another
advantage the Advantage plan is it
includes a prescription plan in it
10:30
you don't pay extra for it you just pay
discounted prices for your prescriptions
so again I like to use a lot of examples
there's a product for every purpose and
a purpose for every product and the
example you heard me use last time if
you're delivering hey are you gonna buy
a motorcycle or a pickup truck well it's
the same thing if you're in a financial
situation where you can't afford
anything your social security is the
only money you've got and it's very
little your main priority is cost who
can I get that's going to be the lowest
11:00
co-pays for my program
you're not as worried about how many
doctors you can choose from then if you
can afford a better plan
you decide okay do I want to be able to
pick from three cardiologists or 30
cardiologists well that's that's the
plan you look at and again there are
this many choices to choose from
Medicare there are about at least now
I'm I'm appointed with nine or ten
companies for the state of Florida and
each one has ten fifteen plans you look
11:31
up medicare.gov you're gonna get lost
all an agent has to do is ask you one
question and it shortens down your
choices down to here okay the question
is what doctor do you refuse to give up
not what doctor do you like who do you
refuse to give up once an agent learns
that he only has to look up the plans
that those doctors take so it makes it a
much easier choice if you don't care
then you could look at any other doctor
12:03
and any other plan you want
so the Advantage plan some people I had
I had someone almost attacked me because
they didn't like the Advantage plans
because they had to go through so many
hoops but they serve their purpose they
also have a maximum out-of-pocket
it's called Moop which means that's the
most you can pay for your medical
service for that year Medicare does not
have that Medicare Part B you pay 20%
well you know you have a hundred dollar
bill that's pretty cheap what happens
when you build hits 20 30 40 $50,000
12:34
$80,000 $100,000 then you're starting to
hit 20% starts to get to be a lot and
that's the difference so that's the
advantages of the Advantage plan and
there are also are some of them that
have PPO is that if you know you're
traveling out of town you call up the
company say I'm going to Oklahoma here's
my zip code and County I'm going to be
in they'll give you all the companies
that all the doctors that are in your
area that you can use in network out of
town otherwise when you go out of town
you are limited to emergencies only you
13:07
break an arm they're gonna fix it for
you
but if you need cut a follow-up you got
to come home you get the flu it's not an
emergency you're gonna have to pay for
it out of town so again it has its
purpose but it has its limitations
the other direction is called a
supplement when most people come to me
they say Mitchell I want something to
supplement my Medicare they don't
realize the word supplement is a
specific product there are ten of them
and they're all so confusing because
13:37
they're labeled a B C F G N and each one
of them is the same as the next meaning
every a is the same every F is the same
so if you go to a insurance company a
insurance company B if you go to John's
insurance company and you want an F it's
gonna be the same from every company so
the only difference is price and service
which ones have a lower price which ones
giving you better service in seven years
14:10
I have not had one complaint about a
supplement here's why supplements pay
for everything a lady yesterday was
asking me well what about this little
thing what about this little thing
supplements pay for everything that
medicare covers by the way it's very
important for you to know two things
about Medicare only what's medically
necessary if it's not medically
necessary they will not do it if I want
a facelift to enhance this beauty here I
14:42
can't get it because it's not medically
necessary if the initiative Medicare
doesn't pay for it the insurance company
not just won't pay for it they can't pay
for it I've had a client call me up and
say my insurance company said they would
pay for this procedure
and Medicare said no the other thing you
just have to know is for a supplement
do you take Medicare with the Advantage
plans you've got to ask are you in the
network and you ask it specifically and
I that's why I teach this you ask do you
15:14
take Medicare Advantage so-and-so
company because if you just say do you
take an HMO from this company they might
think you're talking about under 65 and
not Medicare and they'll say yes and
they might not and once you go it's your
mistake you have to pay the bill with
the supplement it's great you just asked
you to take Medicare anywhere in the
country so
before I told you on advantage plans the
smaller ones you might have get three
cardiologists the ones with the larger
15:45
networks you might have thirty well with
the supplement you might have three
thousand because you can go anywhere you
want America and use a doctor all you
have to do is ask
do you take Medicare now I mostly work
with an F supplement because it pays
when I say everything it pays for
everything
the a a that B the C supplements do not
you're paying a premium so why pay a
premium when you're not getting covered
for everything so if you take the F
supplement it pays everything and the
16:17
reason I emphasize it because there is
one little castle in the things that
covers that other ones don't and that's
called the 15 percent overage you can go
to a doctor that accepts medicare but
doesn't accept the price assignment so
they can they can charge you 15 percent
more 15 percent more on a hundred dollar
bill is nothing on a 150 dollar bill
it's pretty low but on a forty thousand
fifty thousand dollar bill it can add up
so an F covers every single thing I have
16:50
sent people to doctors and they said I
have Medicare and I have a supplement
the doctor looked up on their list I
said we don't take that supplement
client calls me up scared to death I
call the doctor up and say yes you do
when the insurance company sends you a
check you're gonna send it back of
course not
there is no network and what I tell my
clients is don't use the word supplement
for some reason doctors don't understand
the word supplement just tell them you
have a secondary here's my Medicare card
here's my secondary card they love it
because they know they're gonna get paid
17:21
in full
okay the only disadvantage I see to a
supplement is it does not include a
prescription plan so you have to buy an
extra one they're cheap enough you can
get them for $20 you can get it for $30
if you have one for $70 you I only know
two people that have a one for $70 that
they need that one other than that
there's no reason to ever pay that much
so you stay with the lower price ones
because the price of the prescriptions
are basically
the same they don't change that much
17:52
just because you're paying more I don't
know why they even have that plan half
the time as for compliance the
compliance and the rules and regulations
for Medicare are I was in a liquor
related business once and I thought that
was strict the compliance for Medicare
is outrageous if if I'm walking past you
I'm sitting next to you at a restaurant
and you're in the booth next to me and I
hear you crying I don't know what to do
with my Medicare I'm scared to death
it's against the law for me to walk up
to you and hand you my card and say I
18:23
can help you call me I had a gentleman
walk up to me at my gym the other day
and he had a piece of paper ready to
hand me his mother's phone number to
call her up to make sure she had the
right plan I won't even take it to be
tempted it's against the law for me to
make the first phone call I cannot call
you up first you have to call me I can
send you an advertisement and that has
general information about turning 65 but
I cannot approach you first that's
against the law
18:53
it can cost me my license when it comes
to seminars just like this I'm teaching
this is considered educational you
notice they haven't spoken about a
specific plan
I won't or specific companies I won't a
marketing seminar I come here I'm gonna
be talk about one company and I'm gonna
try to convince you to sign up for that
company and I can sign you up
educational seminars I can't even hand
you my business card unless you ask me
for it I make a joke out of it I tell
the people that and then of course they
do ask but I can't I can't have a
19:26
registration for him
I did a C II classes for one of the one
of our members as a matter of fact
Maria wigle Minh and she teaches C
classes and Medicare was part of it and
I can't get paid for it I'm not allowed
to gainst the law I do it as a courtesy
and I love doing it she has a
registration form people sign into the
class I cannot take that form I cannot
buy lists of emails and just randomly
send you information again it's against
19:58
the law one of my favorites that drives
the clients crazy is once I sit down
with you
talking about Medicare whether you sign
up or not doesn't make a difference if
and then you say Mitchell that's fine I
know everything tell me about life
insurance it's against the law I cannot
tell you for 48 hours I can't speak to
you if your husband or wife walks in I
have to have them sign a piece of paper
giving them Commission me permission to
speak to them you also have to sign the
same piece of paper if the neighbor
walks in I can't talk to the neighbor if
20:30
I'm walking out of the house and I see
the neighbors next door
I can't walk over give them my card and
say I just gave your neighbors Medicare
would you like me to help you it's
against the law it's there to protect
you but mostly it drives my clients
crazy so your your four patients the
clients isn't that bad but the rules are
a little tough you cannot leave your
plan except for a EP annual election
21:02
period October 15th to December 7th
except for special circumstances you
just turned 65 you just moved you just
got in or out of Medicaid very quickly
I'll also tell you Medicaid isn't that
hard to sign up for if you do it online
and I can help people show them how to
do that but doctors can drop the plan
anytime they want insurance companies
can drop doctors anytime they want
if your doctor drops the plan you're
stuck with your plan not your doctor
so you either pay to go see that doctor
21:34
or you have to switch so it's a little
tougher on us than it is on them there
are a lot of other little things to go
over in Medicare but due to constraint
in time and the rules and regulations
that Craig are going to give you about
Obamacare and things are gonna be
astounding and probably scare the heck
out of you so any other questions that
you have for more specific coverages or
information I'll be here for the rest of
22:05
the morning I'll be able to help you out
with that but keep in mind again
Medicare also is a very personal
consideration
husbands and wives have different plans
I have a wife who's incredibly sick and
has
one plan and the husband who is
incredibly healthy and has a completely
different plan there are no more groups
everything is completely separate plus
another thing too is when you go from
under 65 to Medicare it's a completely
different animal I don't care who you've
been dealing with in the company and for
22:36
customer service it's gonna change so
you might hate your Pete your your plan
under 65 but that same company might
have a great plan over 65 and vice versa
so and and your neighbors gonna walk in
and say you know you know when you buy a
new car a new appliance and someone
comes and tells you the next day they
found it cheaper
same thing with Medicare you the
neighbors gonna come in and say oh I got
this I got that but does your neighbor
have COPD
does he have low income high income does
he have diabetes again very personal
23:06
very self directed at each person and
that's how Medicare becomes simple
because all you have to know is what
your plan does you don't have to know
what everybody else's plan does you
don't have to know the millions of laws
of what they do and I'll end with this I
teach as I go my main mantra is in
education before enrollment one of the
main things I teach and it works is how
to politely threaten your insurance
company I don't know if I should put
that on the on the air but it's a simple
23:37
thing because when you pay for insurance
I don't care if it's car insurance or
anything you should get what you pay for
if it's not covered I'll tell you you
made a mistake it's not covered but if
it's covered the insurance company
should give it to you and take care of
it and they are graded on star ratings
five stars is the highest the more stars
they get the more money they get they
want to take care of you now it's not
like it was 20 years ago they want to
keep you how they're actually start to
call up your home and tell you hey have
you picked up your diabetes medicine
24:09
we're coming to your house and we're
going to give you a physical because the
more you use their services the more the
government likes them the more the
government gives them the money so that
in a nutshell is the Medicare programs
and again if you have questions after
Gregor's done we'll answer all the
questions thank you
well good morning my name is Craig I'm
with CSR and associates and we write
health insurance that's about the end of
the conversation with me so here's the
24:39
deal you ever do things for a long time
and I must forget what you're doing
right so I've been speaking on the
Affordable Care Act for literally six or
seven years now and the presentation
you're going to see has morphed over
time but I throw the first slide up this
morning and it's been a little while
since I've read back through it again
so around 2010 we passed the Affordable
Care Act the Republicans talk about
repeal and replace repeal and replace
and we end up electing president Trump
and a bunch of Republicans and they say
they're going to repeal any place and
25:10
then they don't repeal and replace and
then Trump signs executive orders and so
I'm seeing here this morning reading
this bottom line on my slide I'd
originally written this during the Obama
administration because the Obama
administration was changing rules and
laws literally on a whim we couldn't
believe anything they passed his law
couldn't believe anything they said we
literally just rolled out of bed every
day and said okay how are we doing this
now and I almost kind of thought that
was going to go away with a new
administration and then I realized it's
not going away so from the past all the
way into the future I think the
Affordable Care Act is going to follow
25:41
this one basic rule which is the
information that I'm giving you today is
most accurate as of today the rules can
change at any moment according to HHS's
rules and guidelines which I thought was
kind of funny so here's the thing
President Obama said that he was going
to cover everybody with health insurance
how is he covering you each and every
one of us has a mandate to own health
insurance or pay a penalty one of the
confusing things that's going on right
now is people believe that the
Affordable Care Act is no longer law or
26:12
that the individual mandate doesn't
stand you might remember that when
President Trump took office one of the
first things he did was sign this
executive order theoretically
eliminating penalties fines and mandates
the problem was that isn't what the
executive order said what the executive
order said was I'm giving HHS the right
to eliminate penalties and fines and
mandates if they want to they did not do
that so right now everybody has a
mandate on health insurance or pay a
penalty
26:44
things have changed right now and so one
of the main ones being in years past if
you owned an individual health plan you
had from November 1st till January 30th
to buy health insurance or change your
plan that's not true this year so this
year is a really big change we have from
November 1st to December 15th if you
call me on December 16th and you say hey
Craig I should have bought insurance but
I didn't the answer is actually I'm
sorry you can't have any health
insurance and you're gonna owe the
penalty for not owning health insurance
27:15
so it's very important that we
communicate to people that that date has
shrunk a lot it's gone from three months
to six weeks everybody know where Craig
is going to be during his in his office
for the next six weeks that's right in
my office now
I told you you're going to owe a penalty
if you don't own health insurance what's
the penalty it is actually 695 dollars
per adult half that for a child or two
and a half percent of your income
27:45
whichever is greater that penalty will
stand as a matter of fact the IRS
released a letter just about four days
ago saying you won't even be able to
file your tax return if you can't prove
that you had health insurance or pay
this penalty and if you so that's the e
filing if you mail your tax return in
and you don't have the proof or you
didn't pay the penalty they're sitting
on your refund until you do one or the
other so the piece about we eliminated
the penalties you can throw that right
28:17
out the window they're now going to
withhold your tax return until you do
one or the other own health insurance or
pay the penalty what I'm really here to
talk about is what happened two weeks
ago and what happened two weeks ago is
the beginning of that week President
Trump signed an executive order doing
three things what three things was he
going to do we're going to do interstate
health insurance we're going to do HRA
reimbursements we're going to do
short-term medical plan revisions what
28:48
we want to know is did it help us
because it was so much talk on the news
this is going to be huge this is going
to be massive everybody's getting better
cost health insurance
they will start with interstate health
insurance
the idea behind interstate health
insurance was we needed to introduce
competition in health insurance so the
idea was if you could buy health
insurance from anywhere in the country
now there's going to be competition and
the health insurance carriers would have
to bring the cost down is that true well
29:19
prior to the Affordable Care Act it was
actually legal for these Association
health plans to exist the Affordable
Care Act made them illegal when they
were illegal did my clients have huge
benefits from doing Association health
plans well kind of and here's why prior
to the Affordable Care Act the
Department of Insurance in a state set
the rules for what a health insurance
plan was here in Florida we had 57
mandates on a policy it can be covering
spinal bifida smoking sensation obesity
29:49
programs whether it covers maternity or
not so we had 57 mandates on a policy
the idea being if I could go by the
policy out of Georgia that only had 20
mandates on it which one's going to be
cheaper the Georgia policy is going to
be cheaper because it has less mandates
the problem is even though they're
allowing interstate health insurance
plans the rules of the Affordable Care
Act still exist unlimited lifetime
maximum preventive care covered it a
hundred percent you know we're gonna
cover maternity and mental health and
30:21
all of these things so the advantage we
were getting from going from state to
state isn't really going to exist in
this circumstance the second thing is
health insurance is not a widget you're
not gonna buy this clicker from anywhere
in the world they can ship it to me I
plug it into my computer hit the button
and it works is that true of health care
well no it's not because we go by a
Vermont health insurance plan am I gonna
drive to Vermont to see the doctor no
I'm not driving to Vermont to see the
doctor I want to see a doctor in Florida
which means that carrier has to get a
network in Florida doctors hospitals
30:53
pharmaceutical companies etc you know
these carriers already sell all over the
country United Healthcare do they sell
all over the country yes
Aetna Cigna coventry Humana they all
sell all over the country anyway this
misnomer that we're going to have them
competing because now they're going to
be selling all over the country they
already sell all
the country that's kind of a long story
to tell you I don't expect a lot out of
Interstate health insurance in this
association health plan thing the other
piece of that that's important is we're
not having a conversation about
31:24
individuals we're having a conversation
about groups so the idea is not that
Craig can go buy a policy in Vermont the
idea was that Craig could have an
engineering firm that was part of the
engineering Association and his whole
company csr and associates the
engineering firm could buy from an
association health plan so even if this
does work this will be a business
solution not an individual solution like
people are thinking the end of the day
I'm not expecting a lot out of that the
31:53
next one is HRA reimbursements this is
massive
if you want to talk about game-changing
things
this is as game-changing it it gets
here's why when the Affordable Care Act
came out and the subsidies existed many
employers started questioning whether
they should be offering group insurance
or not maybe they should terminate their
group insurance give their employees
some money and let them go by individual
policies on the exchange like we're
going to talk about in a minute the
Affordable Care Act said that employer
32:24
is not allowed to give those employees
tax-free dollars to do that in other
words I couldn't hand
Michell $200 tax-free then let him go to
the exchange and get a subsidy and buy
health insurance they said it had to be
taxable money that slowed that
transition down a good bit it didn't
stop it but it slowed it down the idea
behind the HRA reimbursement is now the
employer can give their employee a
tax-free dollar that employee can go to
the exchange and buy an individual
32:56
health plan like we're fixing to talk
about with all tax-free money and it's a
game changer the very second this
conversation came up I had five or six
employers terminating their health
insurance I'm having conversations with
new employers almost daily this is
massive employers are going to terminate
their coverage like it's going out of
style
right going to be a serious game changer
the last one has short-term medical
plans and if you're listening to any of
the news media conversation here what
they keep saying
yes Hey look all the healthy people are
33:28
gonna leave the market in other words
leave the leave healthcare.gov or
individual health plans that are written
guaranteed-issue no pre-existing
conditions
well why that stuff's really expensive
and so by going to a short-term medical
plan the short-term medical plan is
going to ask you a couple of medical
questions they can accept you or decline
you but if they accept you it's going to
be a lot less expensive what the change
here is today short-term medical plans
33:58
can only be bought in a 90 day block of
time some Mitchel comes to me he buys
the plan at the end of 90 days that plan
ends and he had to buy a new one well as
long as nothing happened to him it was
fine or as long as something happened to
him that was quick
it was fine Mitchell breaks his arm he
shows up in the emergency room it fixes
his arm and he goes home and
everything's great
but what if Mitchell got a bad diagnosis
cancer he begins his cancer treatment
the plans going to cover it because it
said it would but the 90 days ends and
34:30
they weren't going to write a new plan
so the risk was Mitchell actually got
something serious and his coverage ended
what they want to do here is extend it
to 12 months so Mitchell would be able
to buy that plan to last the entire year
that's going to coincide with open
enrollment so if Mitchell had cancer and
now he wants to move to Blue Cross he
just flips over to Blue Cross on the
Affordable Care Act and he's good to go
that'll have some impact it'll help some
people be able to buy some cover just a
little more affordable how's this stuff
35:00
going to be implemented well if we look
at the first part the Labor Secretary
has 60 days to develop their association
plan proposals he signs the executive
order they've got 60 days to say here's
what we're thinking then it goes out for
the comment period for another 60 days
or something and everybody says they
think that's a good idea or a bad idea
then it goes back to them to form final
rules then they come out with the final
rules maybe middle of the year now
people have to figure out how do i
implement whatever it is they just said
35:32
they would do so my expectation is we're
really having a 2019 conversation about
this really affecting us this isn't
going to be any time in the near future
Treasury secretary and HHS have 60 days
to develop their short-term medical
rules the short-term medical rules are
going to go fast
we're already writing short-term medical
plans it's really just a matter of them
saying okay you can do it for 12 months
the carrier's can flip a switch they do
it today BAM my expectation is January
February we're up and running with that
36:04
and you'd be able to buy those plans for
12-month blocks of time that's going to
happen pretty quick the last one is the
HRA reimbursement what we talked about
it's going to lead to all the employers
terminating their health insurance the
confusing thing for me about this is
even though it says they have 120 days
to develop these rules before President
Obama left office he actually signed an
executive order making this legal we're
already doing this right now we're
already doing health reimbursement
accounts the employers are given the
36:35
employees tax-free dollars to buy health
insurance it's happening today they're
just going to formalize it a little more
all right we need to talk about how
subsidies work and we need to understand
actually the last thing that happened
that I forgot to talk about the end of
that week two weeks ago President Trump
came out and said I'm no longer giving
subsidies to the insurance companies for
health insurance and everybody thought
the entire Obamacare legislation
37:07
collapsed and it was over that's really
the way the communication happened would
you agree with me then the question we
want to figure out is is that true and
what actually happened so that's what
we're going to discuss if we look at how
subsidies happen on the exchange what
happens is across the top is number of
people in your family subsidies are
available from a hundred percent to four
hundred percent of federal poverty level
what's that mean in English means a
single person can earn up to forty eight
thousand two hundred and forty dollars a
37:39
year and still qualify for a subsidy on
the exchange to help them buy health
insurance family of four can make up to
almost ninety nine thousand dollars and
still get a subsidy to help them buy
health insurance
the median household income in the state
of Florida is about 46,000 dollars what
does that mean it means 60% of us are so
qualify for subsidies on the exchange
then how does it work my buddy David's a
family of four
he made forty nine thousand two hundred
that puts him at 200% of federal poverty
level I'll tell you why that matters in
38:11
a minute Craig he spends all day every
day reading health care law so he only
made sixteen thousand dollars last year
he's at one hundred and thirty three
percent of federal poverty level why
does it matter because depending on the
percent of poverty level I'm at that
determines what percent of my income I
pay for my health insurance
one hundred thirty three percent pays
three two fifty paise eight you can see
how that works then what happened to
David David was at 200% he's gonna pay
six point three percent of his income
for his health insurance forty-nine
38:44
thousand times six point three divided
by twelve David can insure his entire
family for two hundred and fifty eight
dollars a month when I'm asked if
anybody benefits from health care reform
absolutely David's benefiting big-time
huge win for him what happened to Craig
Craig was at 133 percent he's gonna pay
316 thousand times 3/12 Craig gets
coverage for $40 a month huge huge win
what's the $5 question yeah Craig but
what kind of coverage do I get there's
39:15
four kinds of plans available on the
exchange bronze silver gold and platinum
the subsidy is based on the silver level
plan so to give you some perspective I
have silver level plans 30 for the
doctor 60 for the specialist $3,250
deductible if I'm admitted to the
hospital so good coverage maternity
mental health whole nine yards what
happens is I enter David I enter his
wife I enter his kids I come back to
David and say your plan is going to cost
one thousand two hundred fifty eight
bucks a month
39:45
hold on Craig timeout you just told me
David was going to pay 258 that's
correct
David's gonna pay two hundred fifty
eight dollars that means David gets
$1,000 subsidy to help him buy health
insurance once we've established the
thousand dollars David can move up or
down this chart however he wants
so if david says hey Craig I can't
afford 258 how much is the bronze bronze
is a thousand and fifty dollars david
has a thousand dollar subsidy he just
pays 50 bucks to insure his whole family
40:17
david says i want great coverage how
much is the gold Gold's fourteen hundred
david has a thousand dollar subsidy
he has pays four hundred bucks to insure
his whole family how does it work then
David goes to the marketplace and he
picks a plan who heard my doctor doesn't
take Obama care right everybody's heard
that phrase it's actually a misnomer
there is no Obama care it doesn't exist
it's the same insurance companies the
same doctors networks for David that
pays two hundred fifty eight dollars and
40:48
Craig dat pays twelve hundred fifty
eight dollars
it's Blue Cross ambetter Florida health
care plans whatever it's the same plans
the same doctors networks there's not an
Obama care so to speak David goes he
picks Blue Cross emails is $258 check to
Blue Cross government mails $1,000 check
to Blue Cross everything's great the end
of the year David sits down with the
accountant how'd it go David oh it
didn't go so good I didn't make forty
nine thousand dollars I got laid off
halfway through the year only made
41:18
thirty nine thousand dollars Oh David
you shouldn't have paid two hundred
fifty eight dollars a month you should
have paid a hundred and fifty eight
dollars a month David's gonna get a
$1,200 refund right on his tax return by
the same token how'd it go David went
great got a promotion got a raise made
fifty nine thousand dollars Oh David it
shouldn't have paid two hundred fifty
eight dollars a month you should have
paid three hundred and fifty eight
dollars a month David's gonna owe twelve
hundred dollars back right on his tax
41:48
return so all of its going to get
adjusted at the end of the year now
David's really lucky because David's
under two hundred fifty percent of
poverty level he qualifies for a second
benefit called cost share cost share
lowers the deductibles lowers the
co-pays lowers the max out-of-pocket to
give you some perspective
I literally have clients that pay 70
cents a month in premium it's a dollar
for the doctor three dollars for the
42:19
list zero deductible $750 max
out-of-pocket unbelievable coverage this
is the point that brings us to what the
president did when he said he wasn't
going to give the subsidies anymore
here's what happened the Democrats are
in a hurry to pass the Affordable Care
Act and they want to pass it before any
of us really realize what's going on so
within that law they create the premium
subsidy the thousand dollars that
David's getting and they actually write
42:52
it into the budget and they fund it and
it's legal that's not going anywhere
that premium subsidy is legal and it
exists however the next thing they do is
they tell the insurance companies they
have to provide this cost share benefit
this lower deductibles lower co-pays
lower max out-of-pocket but they don't
want us to know how much it's really
going to cost so they never put it in
the budget and they never fund it so for
four years President Obama would just
43:23
walk over to the national treasury grab
a handful of cash and hand it to the
insurance companies and he'd walk over
the National Treasury and grab a handful
of cash in hand the insurance companies
well the president doesn't have the
right to just grab cash and hand it to
someone even if he thinks it's good for
the country he doesn't spend the money
Congress spends the money so some people
sue and it's working its way through the
appellate courts and before it makes it
to the Supreme Court we elect President
Trump well President Trump looks at the
program and says I don't have the right
43:55
to go to the National Treasury and grab
a handful of cash and hand it to someone
so two weeks ago he says I'm not doing
it anymore and everybody thinks that the
whole world's collapsed not necessarily
here's what I want to give sometimes we
never give politicians enough credit for
being smart I'm going to give them
credit in a way that most people
wouldn't expect our Department of
Insurance here in Florida is very smart
they're very astute and they listen to
agents and they listen to how the world
44:27
works and we had already handled this
here's how I want you to ignore 2018 for
a minute because it's just going to make
you confused in 2017 David bought this
silver plan 30 for the doctor $3,500
deductible the total premium was 993 so
David got a 735 dollar subsidy to help
him buy health insurance he paid his 258
bucks
we determined see one of the things
about the way I calculate subsidies is
I'm not calculating the subsidy I'm
45:02
calculating what David pays the subsidy
is the difference but if David wanted
the bronze plan 54 the doctor $6,900
deductible the premium was 921 you apply
the 735 he was only gonna pay a hundred
eighty six dollars for the bronze plan
oh he wanted the gold the gold was 1207
take the 735 out he was going to pay 473
for the bronze plan what did our
Department of Insurance do that was so
smart we had already resolved this we
already expected President Trump to not
give the reimbursement for the cost
45:33
share we didn't think he was going to
slide that money through the back door
anymore so the Department of Insurance
went to the insurance companies and said
how much is that gonna cost you when
that cost-share subsidy goes away the
insurance company said about 31% they
said great load the premium thirty one
percent for the silver plans so they did
the 993 went to $1,300
does David care does David care no David
46:07
doesn't care right David still pays 258
so what happened is his subsidy went up
from 735 to a thousand 42 however we
only loaded the silver plans because the
cost share benefit is only on that
silver plan so if you look at the gold
it stayed at now I mean the bronze it
stayed at 921 now he gets that for free
instead of paying 186 dollars the gold
plan went from 1207 to 1207 now he gets
the gold for a hundred and sixty-five
46:39
dollars instead of the silver for 258
hence the name of my slide
welcome to the gold rush
because now what we're going to have is
a migration of our clients from silver
to gold
this brings up a part we need to talk
about with what's going on with health
care reform we have a very big problem
and the big problem is this the people
in Washington DC believe they can
piecemeal out health care reform
47:09
President Trump is probably honestly
thinking he's not going to give that
reimbursement to the insurance companies
anymore and he's cracking Obamacare
apart and I'm gonna sign this executive
order and I'm gonna crack Obamacare
apart he's not cracking it apart he's
actually sending people to the exchange
that HRA reimbursement will cause
employers to terminate their coverage
because the most compassionate thing
they can do for their employees is
terminate their health insurance
47:40
wait a second Craig what you say in the
old days if Mitchell works for me I
offered Mitchell health insurance
because I cared about him today if I
care about Mitchell I'm gonna terminate
my health insurance and let him go to
the market because of my offer Mitchell
group health insurance neither him nor
his children are allowed to go to the
exchange and get a subsidy meaning
Mitchell says how much for me Craig
200 bucks how much for my kids 400 bucks
now Mitchell's wife calls me on the
48:12
phone cuz she can go to the marketplace
Craig I need health insurance no problem
how many people in your family or what's
your total household income forty-nine
thousand well that puts you at 200% of
federal poverty level two hundred
percent of federal poverty level you pay
six point three forty nine thousand
times six or three but I've got 12 now
I'm ensuring just Mitchell's wife for
two hundred and fifty eight dollars a
month in Mitchell's paying two hundred
for himself and four hundred for his
48:45
kids because I offered him health
insurance instead of him insuring his
whole family for two hundred and fifty
eight dollars a month here's the other
thing the health care reform law changed
a lot of things and one of the things
that changed by
the definition of compassion is I don't
do for words math anymore
I do backwards man backwards math what's
backwards man okay who's got a
calculator I need some help
calculator yep that's right
all right I have a taker so Mitchell
calls me up on the phone he says hey
49:23
Craig I want to get health insurance I
gave great Mitchell how much do you make
Mitchell tells me he makes $40,000 a
year that puts him at 350 percent of
federal poverty level 350 percent of
poverty federal poverty level he's going
to pay nine and a half percent of his
income so we're gonna go 40 thousand
times 0.09 5/12
great Mitchell I can insure you it's
going to be three hundred sixteen
dollars a month Mitchell says wait I
forgot about them two kids
not a problem Mitchell now you're a
49:59
family of three making $40,000 you're at
200% Derek's laughing two hundred
percent of federal poverty level would
pay six point three so we're gonna go
forty thousand times 0.06 3/12 two
hundred and ten dollars I can insure
Mitchell and his children for two
hundred and ten dollars a month because
I do backwards math I don't do forwards
math more people cost less than less
50:31
people if Mitchell then says we'll wait
Craig I got a wife then I just go in and
I say hey great I'm not gonna make you
do the math that makes you a family of
four at two hundred thousand I'll ensure
you your wife and the kids for one
hundred and sixty-six bucks a month
because I do backwards math I don't do
forwards math this is a dynamic change
because the world doesn't work the way
we thought it did in the sense that the
subsidies don't work the way people
thought they did and the at the end of
the day David doesn't care what the
51:03
premium is as a matter of fact the
history of the Affordable Care Act for
me is this this 400 percent of poverty
level when we started this three years
ago that number
was $46,000 was the 400% of poverty
level so if David made the same $49,000
all three years he started down here and
his income is gradually moving lower on
the percent of poverty level chart as it
moves lower on the percent of poverty
51:34
level chart what happens to what he pays
it goes down right because he's not
paying 8 percent of his income anymore
now he's paying 6 he's not paying 6 he's
paying for he's not paying for he's
paying 3 so the irony of this is this if
you fit in this box or your employees
fit in this box they're fine and if you
have a company and the majority of your
employees are in this box the most
52:05
compassionate thing you can do for them
is terminate your health insurance now
that brings up the question of this who
scares Craig here's who scares Craig
people right along this line right down
here I'll give you an easy example I
have a husband and wife they call me up
they're retired they're 63 years old or
something they did a good financial plan
right they weren't rude David they're
all set they make about $64,000 a year
maybe he worked in Martin Marietta and
he's got a little bit of a pension he's
52:36
taken his Medicare every now and then
Martin Marietta wants to call him up
having to come back in and do some
consulting because he's an expert in
missile defense systems the way this
works is I say great you and your wife
at 64 thousand dollars a year you make
you gonna pay about three hundred and
fifty dollars a month for your health
insurance your subsidy is going to be
about $1,400 a month here's what you
need to know Mitchell
if you break sixty four thousand nine
hundred and sixty dollars and you make
53:07
sixty-five thousand dollars you owe
sixteen thousand dollars back to the
federal government do on your tax return
when you file it because you're not
eligible for this subsidy anymore but
Craig they want me to come in and do
some consulting and I want to do some
consulting I don't want to just sit
around the house I'm
happy going and work five ten hours a
week that's great Mitchell but what you
have to understand is you've got to make
ninety five thousand dollars so that you
53:37
can pay the taxes pay the sixteen
hundred dollars a month for the health
insurance just to be even with where you
would be making sixty four thousand
dollars so in reality you're better off
designing the missile defense system for
free or just telling to buy you a soda
and some lunch and you'll come in and
defend our country because you can't
afford to work part time the guys that
are alone this line is frightening to me
now we need to ask the pertinent
54:08
question and the pertinent question is
this okay Craig you told me the
Department of Insurance was loading
premiums 31% I don't get a subsidy I'm
screwed
no you're not I told you our Department
of Insurance is very smart they went to
the insurance companies and they said I
want you to file me a silver plan that's
on exchange only that has this load of
54:37
31% and I want you to file me a silver
plan that's off exchange only and we're
not loading it the 31% so if you come to
me and you're going to get a subsidy I'm
putting you on healthcare.gov the load
doesn't matter if you come to me and
you're not getting a subsidy I'm not
putting you on healthcare.gov you're not
getting this load because we filed the
plans without it our Department of
55:08
Insurance is a very astute one more
thing we need to know about let's say
you're not getting a subsidy and you
want affordable health insurance our job
is to provide solutions to people so I'm
always looking for the most innovative
solutions one of the things we started
doing is we're write business for one of
the Christian sharing ministries and the
Christian sharing ministries have some
medical underwriting but if you're
healthy and you're willing to agree to a
Testament of faith I believe in Jesus
Christ he died on the cross for my sins
they've got plans and rates that are
55:39
super
affordable so at the end of the day much
like Mitchell my job is to figure out
what's the right solution for you do we
need to get a subsidy not get a subsidy
look at a Christian sharing plan not
look at a Christian sharing plan because
we have to figure out what's the right
solution for you
having said that our time is just about
up so I think it's time for us to pause
and see about taking some questions
correct and I'm sure there are quite a
56:10
few questions out here but wait I get to
the microphone to you so that way you
can talk into it for the camera directly
in colonial life a Craig you said when
you file your taxes if you don't pay
that fine you won't be able to actually
file your taxes well my question is you
don't think that let's say if what
you're gonna get back from the IRS
supersedes you'll find you don't think
the IRS is gonna give you your return
your money
56:42
- those dollars dereck at Derek's asking
a really good question why wouldn't i RS
just withhold the fine and send it back
I can't answer that question for sure
Derek because all I can do is respond to
the Articles that we're reading the
articles were reading say you cannot be
file you won't be able to e-file if you
don't either prove you had insurance or
pay the penalty and if you mail a paper
a pin the article says they're
withholding it I'm not an accountant
that's not what I do for a living but we
probably some qualified people in the
room that might be able to answer that
57:13
all I can do is answer it based on what
I'm reading okay I've got a couple one
is first up I'm on the bottom line so I
am worried you know I had to pay back my
entire subsidy last year and I want to
do it again
but I probably will anyway quickly does
does f include drugs does the F premium
include drugs there are no supplements
that include drugs okay so it's F okay
you have to buy a separate policy does
the Christian sharing plan include a
57:43
drug program Medicare or the Christian
sharing programs are a little bit
different they're really designed for
the oh what happens to me you know if I
end up going to the hospital
so when we look at the Christian
cheering plans a lot of them work
differently than insurance for instance
they might say we're not going to cover
preventive care that's not an unexpected
expense we're not going to cover for
medications longer than six months we
won't cover maternity out of wedlock
because we're a Christian program having
said that they also do some things that
health insurance doesn't do one easy
58:16
example of that is you want to adopt a
child we might have some money to help
you adopt a child because that's
consistent with our values this that's
the long answer your question the short
answer is no they're not really just
meant to cover maintenance okay what
last question there is no choice on
Affordable Care Act it's blue cross my
screw or my blue I mean there's just
dead that's not true okay okay then help
me understand how the interstates that's
what I thought I was all excited about
the interstate thing happening because I
58:47
thought maybe some of these people would
come back onto the marketplace yes cuz
everybody left so what she's referring
to is in the individual market what
options you have are dependent on what
county you're in last year if you were
in Seminole County
you could pick blue cross Ave med
Florida health care plans and better and
Mileena but if you are in Orange County
the only carrier that was in Orange
County was either Blue Cross or AB med
59:17
we're the only two carriers writing
business in Orange County that changes
from year to year so this year in Orange
County there's going to be more than
just Blue Cross this year in Seminole
County I think we're actually adding a
carrier to Seminole County as well we
are just now getting our actual rates
and plans for 2018 for open enrollment
that starts on November 1st so what four
days from now or five days from now in
the old days and this is consistent with
what Mitchell would have to say too is
in the old days I did my health
59:50
insurance with my nephew Timmy because
he just got his license look that really
doesn't work today today you need to
find someone that's an expert in the
field that you're trying to find
coverage for the way these laws work the
way subsidies worked and we didn't even
talk about the group insurance today and
what groups have to
but I can definitely do that if you have
a group planning you need to know what's
going on but in today's market you need
to deal with someone that's really an
expert in the area you're trying to do
something with it always amazes me
clients will call me up on the phone and
01:00:20
Mitchell probably has something similar
happen I spent 10 hours looking at
individual plans I'm on the phone with
him for five minutes we got it narrowed
down they've got the right plan they're
totally happy and I'm thinking why did
you spend 10 hours looking at
healthcare.gov by yourself it's a
five-minute phone conversation with me
and it doesn't cost you a dime more to
have me do the research about what
doctors what medications what plans is
the same thing with Mitchell it doesn't
cost you a dime to have Mitchell's
expert advice figuring out your Medicare
solution why would you look through the
01:00:52
foot and a half tall stack of stuff that
you get that's just the way I operate
I'm thinking I'm just gonna go to the
guy that knows so okay Darren this
question may seem like I'm trying to be
funny but I'm not with that Christian
plan they're basing everything on values
not on necessarily what health care was
just over for so in essence again I'm
not trying to be funny if I'm a devil
01:01:20
worshiper I can't go get that plan well
part of getting a Christian plan is you
agree to the testament of faith of being
a Christian so you would be correct now
maybe the devil worshippers association
has a devil worshiper plan maybe they
have not really funny you know maybe
they do but in this particular case yes
you agree to Testament of faith and it's
not even just devil wars first you know
I get people that are Muslim I get
people that are Jewish and they say hey
I can't agree to a Testament of faith
that Jesus Christ died on the cross for
my sins and so that's not a solution for
01:01:54
them my job is to just tell you what's
available and figure out the right
solution for you do you know any no
there are no experts in this field well
I think that wraps up all the questions
definitely a hot topic you definitely a
timely topic and that is the essence of
what we try to do
Mora is provide great education great
opportunities to learn and grow in the
01:02:27
health care community and be a resource
to in this case a little bit on the
patient side which we all are as well as
the medical professionals and providers
that we have please feel free to
continue any of the topics on our
LinkedIn open group we've got a close
group for the members as well as this
video will eventually be archived on the
website and on our youtube channel so
please feel free to check those out and
subscribe and all those sort of things
so this is the last major presentation
we have of the year unless somebody else
01:02:58
wants to show up on Thanksgiving Day
around Christmas I don't think so
so have a great holiday season and we
will have our next major presentation on
the fourth Thursday coming up in January
and we'll have some time to plan and
figure out what some of those topics
were gonna be so feel free to chime in
if you have some good ideas for us we
always appreciate that so have a great
day thank you so much for being a part
of medical office resources of Florida