Tag Archives: uninsured


When a Penalty Is Not a Penalty

The Affordable Care Act requires most Americans to buy qualifying health insurance coverage. Fail to comply with this mandate, and there’s a financial penalty waiting for you come tax time. But when is a penalty not a penalty? When is a mandate not a mandate? Hey, kids, let’s do some math.

The penalty for going uninsured in 2016 is $695 per adult and $347.50 per child, up to a maximum of $2,085 or 2.5% of household income, whichever is greater.

To determine the cost of coverage, we’ll use the second-lowest Silver plan available in a state. That’s the benchmark used to calculate ACA subsidies, and in 2015 Silver plans were roughly 68% of policies sold through an exchange. Even more important, I found a table showing the cost of the second-lowest cost Silver plan for 40-year-olds by state, but I couldn’t find a similar table for other levels.

The least our 40-year-old could spend on the second-lowest Silver plan this year is $2,196, in New Mexico; the highest premium is $8,628, in Alaska. The median is $3,336. Divide the penalty by the premium, and you get 32% of the cheapest premium and 21% of the median premium. Put another way, paying the penalty saves our 40-year-old  consumer $1,500 in New Mexico and more than $2,600 in the mythical state of median.

I did find a table showing the national average premium a 21-year-old would pay for a Bronze plan: $2,411.  In this situation, the $695 penalty amounts to just 29% of the policy’s cost, a savings of more than $1,700.

The purpose of this post is not to encourage people to go uninsured. I think that’s financially stupid given the cost of needing health insurance coverage and not having it. And, personally, I support the individual mandate. I also understand the political obstacles to establishing a real penalty for remaining uninsured.

However, I also believe the individual market in this country is in trouble. (More on this is a later post). Adverse selection is a contributing cause to this danger. The individual mandate is supposed to mitigate against adverse selection. The enforcement mechanism for that mandate, however, is a penalty that, for many people, is no penalty at all.

That’s not just my opinion. That’s the math.

A version of this article was originally posted on LinkedIn.

How to Reach Millions With Life Insurance

The availability of rapid diagnostic technology and the dramatic growth of retail healthcare has converged to create opportunities for the life insurance industry to attract and serve millions of consumers who are uninsured. Increasingly, consumers are visiting retail locations for healthcare. Life insurers stand to benefit in both the short and long term by taking advantage of the convenience of retail healthcare and the availability of rapid testing to speed underwriting.

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Rapid Tests Meet Consumer and Insurer Needs

In the past five years, minimally invasive rapid diagnostic testing has been revolutionized. Its accuracy, speed and ease-of-use have made it a perfect fit for the retail health environment. Rapid tests require only a small drop of blood or an oral swab, deliver accurate results in minutes and meet stringent FDA guidelines. Tests, such as A1c for diabetes or cotinine for smoking detection, can be combined into one kit for ease of use and distribution. And, because results can be seen immediately, rapid tests meet consumer expectations of speed by eliminating the delays inherent in the central lab process.

Faced with declining sales, forward-thinking insurers and reinsurers are using these new tools and processes to enable rapid issue of insurance. And, when combined with more traditional measurements such as height, weight and blood pressure, rapid tests provide insurers with the information they need to make accurate and quick decisions on a life insurance application. The data can be electronically transferred from the retail site to the insurer to enable immediate, rule-based decisions. As a result, an insurance offer can quickly be delivered to the consumer—often by the time he or she arrives home—delighting consumers and shrinking the life insurance underwriting process considerably.

Growth of Retail Healthcare Creates Reach into Neighborhoods

Retail pharmacies and urgent care clinics are quickly becoming neighborhood clinics. They are able to provide a broad range of services, with the majority offering health screenings and wellness services to fulfill the growing consumer demand for affordable, accessible healthcare in a convenient and professional setting.

This trend is one that we can expect to grow and broaden. According to Accenture’s recent analysis, “Walk-in retail clinics, located in pharmacies, retail chains and supermarkets, will add capacity for 25 million patient visits in 2017, up from 16 million in 2014.” The Urgent Care Association of America reports similar growth. There are now 7,000 urgent care clinics in the U.S. that see three million patients each week.

A New Process for a New Generation

The availability of rapid diagnostic testing in retail settings offers a unique opportunity for life insurers to address several challenges in the application process that are cumbersome to today’s consumers. Many of these consumers simply disappear because the insurance process takes too long. Rapid testing speeds the delivery of results to the insurer so it can quickly make an offer to the consumers. Consumers are able to complete testing in a convenient and professional setting.

In an age where speed of information is not only expected but demanded from consumers, this new paradigm provides insurers and reinsurers with a process that consumers will applaud with their loyalty and their life insurance dollars.

Don’t Be Dissuaded by Medicaid Myths

Brokers hesitate to offer Medicaid enrollment services to their clients because of the perceived stigma surrounding them.

But the reality is that those stigmas are all talk and no bite – most Americans don’t have a problem with public benefits like Medicaid. In fact, those who qualify for it generally prefer it because it offers lower costs and better coverage than many private plans do. Brokers who offer this government-subsidized coverage give themselves an advantage over those who don’t while better meeting workers’ healthcare needs.

Busting the Medicaid Myths

The common notion that Medicaid provides inferior coverage when compared with private plans is patently false. Study after study has shown that Medicaid recipients are actually happier with their coverage than enrollees in individually purchased plans or employer-sponsored private plans. In three southern states, low-income residents said they preferred Medicaid’s quality of care to that of private plans. Nationwide, 87% of Medicaid enrollees feel positive about their health insurance, compared with 73% of those with private plans.

Medicaid’s doubters note that only 66% of those eligible for Medicaid are enrolled and say the figures demonstrates inadequacies in the program. Under-enrollment has many causes, but pride is not among them. Many people don’t know they’re eligible for Medicaid, and the application process is complex. In addition, the application process is largely online, and a significant number of low-income individuals lack computer skills or access to the Internet.

The Truth About Medicaid

The reality is that Medicaid provides affordable, high-quality care to working people. It also presents brokers and business leaders an opportunity to lower costs while increasing the number of employees who have health coverage.

Contrary to the misconception that Medicaid offers little coverage, the program provides more comprehensive coverage than most private plans. Medicaid includes vision and dental benefits for children throughout the country and for adults in most states. It also includes benefits like non-emergency transportation and substance abuse treatment.

What’s more, care under Medicaid is just as accessible as care under private plans. Only 2.8% of Medicaid enrollees can’t access nearby care – while that number isn’t zero, it does suggest that the vast majority of enrollees can find primary and secondary care.

Not only does Medicaid cover a wide range of services, but it’s also quite affordable. The vast majority of Medicaid enrollees pay no premiums, and employers pay no additional cash for their employees enrolled in Medicaid. Even in the handful of states that do have premiums, enrollees typically can’t lose coverage for failing to pay. Medicaid has no deductibles and minimal co-pays, often charging just a few dollars for prescriptions and doctor visits. Medicaid covers the whole family; unlike many private plans, there are no drastic rate spikes for dependent coverage. For many families, Medicaid is the only path toward insuring the whole family.

In addition to saving money on premiums, people who have Medicaid are significantly less likely to incur significant medical debt than eligible people who do not sign up for Medicaid. Medical debt remains the most common cause of bankruptcies in the U.S., and Medicaid reduces the risk that a devastating medical complication will also bankrupt an individual.

When brokers help companies provide Medicaid enrollment services in the workplace, most employees are grateful to get help with this process in a comfortable and familiar venue without having to make appointments during their limited hours outside work.

How Brokers Can Benefit

It’s clear that Medicaid benefits enrollees, but what about the brokers who provide the benefits? Medicaid helps them, too.

Offering Medicaid enrollment support sets brokers apart in a crowded field. By bringing a new solution to the table – particularly one that many people are unaware of – brokers distinguish themselves.

Medicaid options also represent cost savings for employers, so brokers can find footing among business clients if they choose to offer Medicaid. In an increasingly commodified health insurance market, the ability to provide an option that requires minimal or no payroll deductions while offering access to high-quality care gives brokers an edge over the competition.

If attracting business clients wasn’t incentive enough, brokers can also earn sizable commissions through third-party enrollers on all workers they enroll in Medicaid, including those who were previously uninsured and thus generating no commission at all. At the end of the day, these additional commissions can actually generate more revenue for brokers than they would receive without offering Medicaid enrollment services.

Employers associate high costs with high quality, but that’s not always the case in the world of healthcare. Brokers who help employees find the right coverage for the right price help everyone save money while providing high-quality care to those who need it.

With Medicaid myths busted, it’s up to brokers to help individuals access care when they need it – and for a reasonable price. As the American population becomes increasingly insured, Medicaid enrollment continues to climb. Brokers who don’t offer Medicaid enrollment support might find themselves on the outside looking in if they fail to provide their clients with the cost savings, coverage and care that Medicaid brings to the table.

Affordable Car Insurance for Under-25s

Parents of new drivers know what they are up against when they are faced with insurance rates, but the increased premiums can still be a bit of a shock. Because teen drivers are considered to be the most “at risk,” insurance rates are expensive. In fact, insuring a young male driver may boost an insurance bill by 92%, while a female driver of the same age will boost the bill about 67%.

Before You Insure, Talk With Your Teen

Your teen may assume that, as soon as she is licensed, she has the freedom to drive immediately and as freely as she wishes. Before you insure your teen, talk to her about your expectations, such as distraction-free driving or driving during daylight hours. Make it clear that if your expectations are not met, you can cancel insurance and revoke driving privileges or you can ask your teen to take some of the financial responsibility of the insurance premium. Given the hefty price tag, you will probably have a teen committed to safe driving. Make decisions that work for you and your family and stay firm with your expectations. Remember, your teen driver must be insured, even if she drives infrequently.

Holding Your Teen Accountable for Safety

If your teen agrees to drive safely and adhere to any of your driving rules, he will most likely have the best intentions of sticking to it, but teens are sometimes easy to persuade; the whole peer pressure thing is still alive and well, including when it comes to driving.

Fortunately, there are apps and tracking devices to monitor the way your teen really drives. While you may feel like you are overstepping your grounds of trust, think of monitoring as added security. These apps/devices will not only encourage your teen to drive safely and keep him safe on the road, but may also get you an insurance discount from certain companies:

  • Tracking Driving Habits With GPS: There are several relatively inexpensive products on the market that plug directly into the car’s diagnostic port and track driving habits. You can set particular speeds or perimeter limits, and if your teen driver exceeds the speed or goes “out of bounds” you will be notified via text or email. Being able to “see” the way your teen really drives can help you have constructive conversations about her driving choices and habits. There are also a few apps on the market that will do the same thing as the plug-in tracker.
  • Prevent Texting and Driving: One thing that most teens will continually try to do is text and drive, regardless of the laws or safety concerns. Rather than struggling to take the phone away, install an app that will prevent your driver from texting while driving. This app must be turned on by the driver (so there is a level of responsibility and trust required), but once it’s working, the app will prevent the driver from seeing or hearing any incoming messages or calls.

Decreasing Insurance Rates Before 25

While insurance rates often decrease when the young driver turns 25, there are ways to have discounted insurance for your teen. Depending on your insurance, you may be able to receive a reduced rate if:

  • Your Teen Gets Good Grades: Some insurance companies offer a discount if your teen driver maintains a certain GPA. This is just another incentive for your teen to try harder at school. The situation is basically a math problem: Good grades=Car privileges.
  • Drive a Safer Car: Although a standard sedan may not be your teen’s dream car, if it’s got a good safety rating and airbags/anti-lock brakes, you may be able to receive reduced insurance.
  • Take a Class: Many older drivers can receive an insurance discount if they take a class to brush up on their driving knowledge, and some companies offer the same for teen drivers.

If your teen commits to driving safely, makes efforts to keep insurance rates low and keeps a clean driving record, his car insurance premium should be lower before the magic age of 25.

Whether your teen driver is in a crash with an uninsured driver or if you fail to provide your young driver with insurance, you may need to hire a car accident lawyer to help you sort out any legal issues in the event of a car accident.

Private Exchanges May Be the Free Market Solution to Cost Control and Healthcare Consumerism

While the Patient Protection and Affordable Care Act (PPACA) is sometimes shortened to the “Affordable Care Act” or ACA, the act has few features that will make insurance more affordable.  Government studies and industry experts have indicated that strict coverage mandates, limited premium classifications, community rating, added benefits, single risk pools, and price compression will raise premiums more rapidly than if the ACA had never been passed.

The development of exchanges, both government and private exchanges, are part of an evolution that will change the way insurance is sold and bought.  It is a new way of connecting products with customers.   Government exchanges are likely to be used mainly by those qualifying for a federal subsidy.  The standards and restrictions on government exchanges are likely to attract poor risks and high cost claimants.  The government exchanges will use government paid “navigators” rather than independent licensed agents.  The government exchanges and navigators are not expected to offer supplemental products, life insurance or other products and services.

Private exchanges may be the free market solution to real cost control and lowering the number of uninsureds.  With 40-50 million uninsureds, the traditional agent distribution system for insurance is not working.   About 60% of the uninsured are under age 35.  Studies conducted in Georgia by the Center for Health Transformation Uninsured Working Group showed that 35% of the uninsured could afford insurance but did not know it.  Another 40% needed lower cost options that were not available to them either because insurers emphasized high premium products, or because existing state laws or legislative mandates increased premiums and favored insurers over consumers.

Many uninsureds work for a small businesses that do not offer insurance. They may be self-employed, part-time, or doing contract work.  In most cases, the need is for individual insurance, not group plans.  Selling single policies can be time consuming with little financial rewards for an agent.  Many potential individual sales are halted at the kitchen table when in the process of completing an application issues arise that could cause a declination.   Information derived by an insurer during the underwriting process is typically fed into an industry association called the Medical Information Bureau.  That information is shared across companies and a declined health application could have ramifications for future applications of life insurance, disability coverage and other forms of insurance. 

Private exchanges are developing that will offer individual and group products that emphasize wellness and treatment compliance for those under medical care.  PPACA requires insurers to “community rate” their products.  That is, individuals or small groups will not get direct credit for healthy activities.  New entities are forming that will likely attract healthy individuals and the less healthy members interested in getting better.  Developing private health cooperatives, captive mutual companies, and new insurers may be unencumbered by an existing unhealthy membership or a current business model that limits attracting customers willing to be engaged in healthy behaviors. 

Healthcare consumerism is more likely to emerge through private exchanges than government exchanges.  Private exchanges will provide a transition from employer-based insurance to individual-centered or consumer-centered insurance.  In theory, both large and small employers will be able to purchase health insurance through the private exchanges, and their employees can choose an individual health plan from those offered by participating insurers.

Time will tell.  We are in the beginning stages of a major market revolution.  We already know that government exchanges as originally promised for small groups have been delayed one year until 2015.  As private exchanges come on line, I believe each will be a little different and offer varying levels of products and services.  For awhile it will be a “wild west” show.  Ultimately, the success and failure of each exchange’s product and distribution model will lead to consolidation and better products, services, convenience, help, and information for the consumer.  In the end, more product competition and price transparency will lead to more citizens being insured and lower insurance costs will prevail.  This is the way free markets create successful products and services that consumers want to buy.