How will the Affordable Care Act affect you? Friday May 10, 2013 I appeared on the “When Wall Street Meets Main Street” Talk Show on K-Talk AM 630 to discuss how to navigating upcoming health insurance changes. To learn more about how the Affordable Care Act will affect you, check out this link to listen to the show...
Good morning and welcome to in Wall Street meets Main Street. This is your host Alan blood. I'm here in studio today with a great guest, Tim Jackson, here from health insurance specialists. Good morning, Tim, how are you?
I'm doing great. We're to talk about everyone's favorite subject, which is health insurance today, particularly as relates to what's going on with the changes with the Affordable Health Care Act, how that impacts you how that's gonna impact your business. If you own a business, if you're employed for a business, what that means. And if you just don't have insurance, what that means is, the economy is driven right now more by stimulus and and money printing and regulation, and the effects of those items than really anything that's legitimate or long term. And the biggest piece of that regulation, of course, that's going to be facing you right now is the Affordable Health Care Act, the aspects of it that are already in place, the things that are going to continue to come.
When we look at what's happening to our budget, when we look at where our money goes personally, when we look at where our money goes on a national or even on a state level, a enormous amount of that money is going towards health care, health care related costs. And that number doesn't seem to be going down, we've talked about this on the show, we've talked about what you need to do, I mean, clearly, you want to have lower health care costs, well, the best thing to do is get in better shape and have better health. But the reality is, we all are going to have to carry insurance. And you probably should carry insurance. If there's a devastating health issue that occurs to you or a family member, where where the costs of healthcare have gone, it is most likely for most people, impossible to cover those expenses on your own. If you're just thinking you're going to self insure for your health care, I hope that either you are the most healthy person on the planet and you don't walk outside, breathe, eat, or interact with other people, or they have an awful lot of money, because that's how much it's going to cost you. So Tim, again, welcome to the show. Thanks for coming on today. I appreciate you being here. Thank you. If you've got questions on on anything we talked about today, or you just got a question about your health insurance, or how this is gonna impact you give give us a call 801-254-5855. Or you can reach out to Tim directly through his cell phone after the show. We'll give that number out a few times 801-718-0051, or we'll give you his email and when website. So Tim, tell me a little bit about what's going on right now. And for anyone who's just has been in the sand, what's happened in health insurance the last six months. First off, let me give you a little bit of background about myself. Just Just know, I've been selling health insurance only it's all a sell as far as insurance for the last five years. And it's been an interesting ride to see how health insurance has changed. I do want to make a point about something you said I see. When we talk about finances and people's homes. Right now in today's world health insurance has been one of the most expensive items in a household, when you're over your cost increases are just astronomical relative to anything else. The average rate increases 12% a year has suffered for the last how long period of time, oh, goes back, I'd say 10 years 12% a year. So in theory, we're sitting in inflation of somewhere around two to 3% by the government's official index. And if you take food and energy into that it's you know, clearly higher, right? But I don't think even that is hitting 12%. Right. And and just to defend insurance companies, I guess in some ways, this is more than just insurance companies taking a 12% profit increase. This is really health care cost related increases what I would say, and you know, that's a whole other show to talk about. But you Yeah, it's interesting. So when we talk about household in, you know, income and household expenses, it really is one of the more expensive items in a person's home. Well, To put that in perspective, education costs have gotten a lot of press lately, and that's been one of the big discussions about what's going on with the cost of education, student loans becoming a rising share of our national debt and of individual household debt.
education costs have gone up by a total of 20% over the last 10 years total, which is still pretty astronomical, when you figure the incomes haven't matched that by any stretch of the imagination, right? You know, income clearly has gone up significantly less than 20% over the last 10 years. So if education has gone up 20% over the last 10 years, you're telling me health insurance costs have gone up 12% per year, yes. for 10 years. Yes. So what is that about 150% increase over a decade in just your health insurance premium costs. And so my point I like to make to people is that if you're if this is either the most expensive or let's say the second most expensive item in your household, maybe housing and then health insurance, wouldn't you? I mean, yeah, I mean, who has a car, you know, who has a car plan that said $900 a month anyway. So
what I like to say if you're paying that much, if it's a second most expensive item in your home, don't you really want to know what you're getting? And I think that's the biggest frustration with health insurance is people are like, Hey, I pay less money. But what am I getting? Because I don't quite understand how it works. How often is you're speaking to somebody do you find that to be the case where they know Well, I've got some insurance and it's through these guys and here's my card and here's what my copay is, but
Yeah, I really don't know too much about it beyond that is that pretty common? Most of the time? Most of the time, most people don't even even insurance people have a hard time keeping track of what their deductible is, and what's their copay? And what is coinsurance? And what is the maximum out of pocket. It's really hard for people to understand that and keep track of it. Well, when you when you hearken back, Nancy Pelosi, his comments about of the Affordable will call by its proper name, the Affordable Health Care Act, right?
When when you remember her comments of, well, we've got to pass it out what's in it, I think maybe that's the way that people approach their health. And boy, the duration that she's taken for that statement that she made, which was clearly just insane, right. And yet, that's the way that it seems like most people deal with their own personal health insurance and their coverage as well, you get those big binders, and I'm right there with you. I'm in the same boat. And I get a big stack of papers in an envelope. And you know, once a year, once every six months, I get all kinds of information. And I say great, I take the card out, I stick it in my wallet, and I put the rest of it in the file. Exactly. And that's it. Yeah. Anyway, so as a as a health insurance specialist, and a professional, an expert in that industry. It's, I feel like it's my job and my duty to help people understand, you know, what they're getting for their hundreds of dollars, they're spending a month, how difficult is that? To really get a handle on that for most people? I mean, is it something where when you sit down and you look at it, you can you can tell the typical client, the typical person, listen, here's what your coverage really is? Or is, it seems like there's so many different aspects of it for me, and maybe that's the reason why most people don't really delve into it, there's so many different moving parts, that it's hard to really grab a hold of them, right, and hold them in spaces long enough to really figure out what's going on. Yeah, there are and I think that's what overwhelms people is they get like a big booklet and say, Hey, here's your benefit summary, you get like seven different ways you're gonna get charged for they get like a phone book. And so a lot of people get frustrated with that. But I feel like, there's really about five parts to it that people really need to understand and, and you know, maybe we can talk about that later. But if you can understand just your deductible, your co pays your coinsurance, your out of pocket Max and your prescription that's going to help you the best. And anyway, so, yeah, that's where I see I see that a lot. That's great. Well, I appreciate you sharing that. What do you what do you see happening for the availability of those that have had issues getting insurance in the past, or somebody's got a pre existing condition. In the past that may have been difficult to get insurance or to change carriers. I've had clients in my mortgage practice where they stay with an employer for much longer than they would have liked to, or in a particular job career field much longer than they would have liked to, because that's where their insurance is, and they know if they change they're gonna have a really difficult time is the changes that we're hearing about is portability of insurance going to become easier is is getting insurance with a pre existing condition become becoming easier with with these changes, portability, you know, that's sort of still an answer that we don't quite know yet. But I would say as far as getting insurance, and I'm going to kind of expound on that a little bit. Yeah, it's in today's world with health insurance, you can still be denied for having medical risk. And for some little some, what some would say maybe something very little or something I've had since I was a kid, and it's actually managed quite well, they can actually be denied for that today. And no longer rule that rule apply on January does not change. That's January, one of this coming year, you're going to have you've got a pre existing condition will no longer be a reason to deny, right? Well, the skeptic in me says that, that means they're just going to find another reason to deny coverage, I mean that other loopholes available for the insurance company to look at, or is it just gonna be a premium that's part of the rule that no one can be denied? A couple of years ago, one rule that came into play that's from the Affordable Care Act was that no child can be denied. And so that's kind of been going on for a couple years and then January 120 14, no adult will be able to be declined. Okay, all right. You've got questions Tim's got answers, give us a call. You don't want to 545855 We'll be right back after the break. Stay tuned.
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Welcome back when Wall Street meets Main Street, this is your host, Alan blood. I'm here with Tim Jackson. From health insurance specialists, we're talking about health insurance and how this impacts you. Specifically, as it relates to the Affordable Health Care Act, aka Obamacare, what this means for you and how this is going to leave your healthcare situation in the coming years. Gold I mentioned before gold had been up lately, it's down 45 bucks today. So we're seeing a little bit of correction there, the stock market is off a tiny hair. And you know, but it's still sitting well over 15,000 points. Again, that's a big benchmark. And that's a big deal. When it comes to the insurance piece here we were talking about before the break the going forward, Tim January 1 adults cannot be denied coverage based on pre existing conditions. Right? So what's that going to mean for premiums? I've got to imagine that's going to cause great questions, some real significant increase across the board, right? So one of the things that there's two ways that they're going to be rating in the future, they call it community rating. And that is basically how old are you? And do you smoke? zip code stuff, too? Or is it just is it you and your neighbors? Or is it just you and you and your smoking tenants? Yes, that's it. How old are you? Do you smoke? That's it. And of course, you know, every state may breathe differently. But basically, that's it when it comes to the federal exchange that sets
so I there's incentive, you better he better drop? Drop the cigarettes quick. Yeah, right? Kidding. So that's gonna be the kicker, okay. And I use the example of, you know, if you were to pull up to a mechanic, and you pull up your car, and they say, I need my car fixed, and the mechanic can only look at how old your car is, and if it's smoking, and then he's going to give you a rate, he's going to charge you based on how old your car is, and what doesn't smoke. can I fix my car? Well, how old is smoke? I'm not sure if there's an $18,000. Yeah. So that's how that's how that's going to be rated. And of course, they've done all kinds of science and math behind to do this. And sure.
It's quite a mess of how it's going to do it. But is it the you know, the question is, is it going to be affordable? Really? And yeah, really, it would seem like the rise so misnamed, because the only people who are going to carry that burden is going to be the consumer. I mean, there's nobody else to carry the extra burden. Exactly. So it doesn't take much to figure out that, that rates, if you know you were running a business that you would probably have to charge more, because you're going to be taken on more health risk, to be able to profitable, so it's not going to take much to figure that out. There are more taxes and fees that go along with that. And don't think that just because we have the Affordable Care Act, that these average rate increases are going to go away, those health percent increases that we've seen for an extended period of time, those aren't changing health care costs will continue to rise as long as we live in America, and you know, you have the Cadillac of all health care. So yeah, it will rise. Now to answer the question about is it affordable? Will it be affordable? A lot, you know, depends on your company and your situation. But there is one thing that if you that will be available, if you we can kind of get into this more later. But if you make less than four times poverty, you will be eligible for a subsidy if you go on the federal exchange. And that's what's going to be interesting to see when you talk about Florida. What's that level here in Utah? Do you know?
Well, it seems like it's somewhere around 22,000 a year for household if I remember, right. So
let me actually,
let me pull something up, you know,
for a family of four, we use this example, for a family of four, which is a mom and a dad and two children. If you make less than 23,000, that's poverty. Okay. So four times poverty would be 92. So you've got a family of four, you make less
The 92,000, there's going to be subsidies that I'm assuming are going to come in the in the form of tax credits or some tax advantages. subsidy at the time of paying a point of sale subsidy. So, but there again, boy, that that's going to encompass a significant amount of the population. Yes. Because 92,000 a year for family of four is probably the majority of the state of Utah. Right. And so you've got a significant amount of the population getting a subsidy, which means, like all other subsidies, yes. Who's gonna pay them for? Who's gonna pay the bill? So obviously, who's going to pay for it? Right here, we ask the question, how long will these subsidies last? Yeah, no kidding. Wow, I was not aware of that piece. Yeah. That that's kind of shocking. I mean, that's gonna take affordable right out of affordable health care. Well, now you've got a question on the air about insurance carrier. coverage? What's on your mind today? Well, you won't be denied insurance. But what kind of health care? Would that give you? Will you be getting denied certain health things if you're over a certain age, so you get the coverage? You can't be denied coverage? The question is about the quality of care, right? What type of items will then be covered or won't be covered? Who's going to decide what that coverages? Can't even have it? Because you're too old? That's good question. So the answer on that, yeah. So when we talk about, there's still a split of those over 65 will have Medicare and those under 65 will be on, you know, our, our health insurance plans that we're talking about? And if you cannot be denied coverage, the plans, there's no limit to the kind of plan you could get. Well, you can you have coverage. But are there certain medical procedures that are going to be denied? Because you're too old? No, really? So I guess that's gonna depend your your coverage for those procedures, that would depend on what plan you select, and how much premium you're paying, right? Assuming, right. And so mostly what I'm talking about with the when I talk about not being denied coverage, that's for those under 65. And these are replants. For those that are that are under 65. When you get above 65, that's in Medicare. And that will continue to remain right you can you can continue to pick up Medicare without underwriting today. So but that's a real question. I think, Lynette what the quality of care is going to become if everybody has to get coverage? Who's going to decide what's paid for and what's not. And I you know, that's where these discussions of the so called death panels and things like that come up. And that's gonna be real concern. I guess the question on that is, you've got to talk to an insurance specialist and find out. Okay, now I've got covered what exactly does this mean for me? And what is and isn't going to be part of whatever I've got to pay for? Yeah. I think that's a great question. I don't know that there's an answer that until you're actually looking at your specific situation, how much your premiums being paid. Yeah. And I think time is gonna tell, you know, we're talking a lot about today, but time will tell how that works out. All right. Hey, Lynette. Thanks for your call. I appreciate listening.
When and I guess the best advice there again, would be everybody's situation is going to be different. Yeah. And you really need to know what's going to be covered for you. So you've got health insurance, but is it going to be you know, the, the worst health insurance on the planet, you're going to have an enormous copay, you're going to have, you know, significant annual out of pocket expenses or not. And I guess that's going to be a function of how much premium you're paying, much like it is now. Right? So there are other rules that go along with this. And that's the deductibles can't be too high. How did they determine what those deductibles are going to be? What's the 2000 for an individual's the high for an individual, so a high of 2000 everyone has to have coverage.
So that's the high on the deductible. And then they're also they, they've, they've been coined are termed the metallic plans. And the metallic plans are going to be plans that will have 9010, coinsurance, 8020 7030 and 6040. So the whole idea is that not you're, it's Yeah, you're gonna get insurance and you can't get like a bad plan. They don't want to say your deductible is going to be capped, but then you've got your 6040 8020 whatever it might be your percentage of costs that fits your pocketbook, which could become very very significant. Yes. So if your deductible is going to be 2000 your premiums is going to be you know, wherever it is, and maybe you've got a 6040 coverage that means you still got a significant amount of money you've got to come up with any major medical that you encounter. I foresee the supplements company doing really well when this kind of So what'll happen is you'll see somebody that can't afford a really high premium and so they'll go with a 6040 plan with a $2,000 deductible and they'll pick up supplements to offset what Aflac type of an awesome life Aflac there's a few carriers out there that sell like accident plans and hospital plans. So I see that big coming they're gonna in fact they're really excited about it. No kidding. Well, they just made well that's the real kicker with regulation is it seems like
when you're when you're regulation is just taking the same pie and cutting it up into different pieces. There's no more pie to go around. It's just different people going
To get a different slice, yeah, you're gonna, you're gonna take a little way from one. But that means you're gonna give a little bit more to somebody else. And that's all this seems to be doing is just shifting the slices of the pie around to different people. Yeah, rather than doing anything that's either going to increase or decrease the actual cost of it, right? It's just going to shift who carries that cost? Yeah. So So what's the requirement now as an individual,
who, let's say you've got somebody who's either insured through an employer, or they're not insured, and their employer is no longer going to cover the insurance? And I've talked to a number of clients that run businesses, and they're looking at the same way at this point, it sure seems to us that it's going to be cheaper for us to pay whatever the penalty is, then actually offer insurance plans. So we're just planning on paying the penalty. Yeah, what's going to happen to that individual? Does that individual then need to go out and go into one of these extra insurance exchanges or find an independent insurance coverage? Yeah, one point I want to make, as far as that subsidy goes, if somebody works for a company that offers, let's say, I worked for a company that offered health insurance, I could not say I don't want the company plan, I'm going to go to the federal exchange and get a subsidy, I would not be eligible for the subsidy because I work for a company that offers it. So in your situation, though, if I if my company says I'm going to drop the pant plan for their small business, and they never had a plan on Friday, don't write and I see a lot of small business in Utah is made up of so much small business, small business employs less if you have less than 50 employees, you're not required to offer insurance regulation, is that going to change? No. So that's still the same. So the majority of businesses have less than 50 employees, yet, so they probably don't have group plans. Or if they do, they're going to become very expensive, and they'll probably drop them, they are very expensive, I see that it says very big strain for blue collared and small business becomes a real big deal. So then those individuals will be able to go to the federal exchange, where there will be some type of a methodology for calculating their income as a function of the poverty level four times the poverty level. Yeah. And then there's some subsidies there any any knowledge yet on what those subsidies are going to look like, or what those dollar amounts will be, or how that's going to work. There's some stuff that's been printed already, I say, the Kaiser Foundation has a lot of stuff that you can actually they have a calculator, you can input. At this point, the only real hard numbers I've been able to get is for a family of four. And looking at coverage, that would be something like a
like a 7030 kind of plan. These are some things but here's this is an example. And these are all been thrown out there. And you know, who knows what this is going to hold. But let's use a family that is
would say the average income in Utah is like 50,000, median income 62,062. So their their premium is going to be anywhere for a monthly premium between $386.05 147 a month. That includes the subsidy. That's, that's a lot less than they're probably paying today. Yeah. So to understand how that works, that I call it the point of sale subsidy. Yeah. And so the insurance company, they're going to go through the exchange and say they want a plan and they get something that's $400. And they pick whatever carrier Blue Cross what issues because it's generic, they pick Blue Cross, and they're going to pay $400 to Blue Cross. Well, the plan actually costs, let's say, $1,000. Okay, Blue Cross is going to the federal government say pulling out the other 600. And and this is where the real cost of this Affordable Health Care Act comes in. It might be less expensive on an individual pocketbook. Yeah. As compared to what your insurance premiums are today. Yeah, but who's gonna come up with that? 600 bucks? Yeah, it's just it's still gonna be you when it's going to be you and all of your neighbors through tax through tax and fees. It's going to be taxes and fees. I mean, there's there's nothing affordable about it again, it's just shifting pieces of the pie. Yes. Phenomenal. Yeah, that sounds like a great plan. Yeah.
And the best part about it is it's only seven months away. Nobody really knows what it looks like. Yep. Even better. All right. We'll be right back after the break for your questions. Give us a call 812545855 when we come back, HSA plans we're gonna talk about how those work and what's going to happen after this goes into effect.
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Welcome back to when Wall Street meets Main Street. This is your host Alan blood. I'm here in the studio today with Tim Jackson from insurance specialists. We're talking about insurance coverage. The the unfair comments that we're getting
are in the same vein of where I am out on this thing with insurance, which is Is there any way to talk about this? That's not terrifying? And unfortunately, Tim, is there. No, there's really not. It's it's a big deal. This is really going to impact. A lot of people. I used to say this is going to impact every citizen of the United States. But we just learned that this does not apply to Congress.
But everyone but Congress this will affect so if you're not in Congress, this matters to you, right? And if you are in Congress, why don't you come on down? We'll have a chat with you. Yeah, exactly about this plan, I have to love to pick your brain a little on what you're thinking.
So with this, and really, I guess the corollary to that is yes, this is terrifying. And there is an enormous amount of unknown going on here. Like we're talking about. I mean, this is seven months away. The enrollment you said was in October? Yeah, enrollment for the federal exchange starts in October. Okay, so the enrollment is in October. So really, there's only about four or five months to start making some decisions here, right to get to the place where you can, how do people find out what their options are? I mean, what what does somebody do if they're listening this way? How is this going to impact me personally, Lynette, who called in earlier? Great question, what is this going to do for my level of care? What's the best way for somebody to start planning now for what this is going to mean for them? Well, you know, the thing that's going to go through people's minds is one do I do I work for a company that offers health insurance? And is it an affordable health insurance plan? That's a questionable term, but paying 12 $100? Right, deductible, but they actually have, they actually have determined what is affordable, it can't be more than this is kind of interesting. Follow my math, it can't be more than 9.5% of the person's annual income is that gross income? So if you make 60,000 a year, if your premiums total of more than $6,000, for an individual, wow, which it's going to be? Yeah, I mean, it's gonna be it's gonna be more than that. Yeah. So unless you have a very substantial income, you probably don't have what would be deemed affordable health care such such brand would be eligible for these federal exchange? Yeah. So the question they'll go through, let's say, Do I work for a company that, you know, that offers an affordable plan? And then the question, if I was working for a small business, I would ask the employer, are you going to continue to offer health insurance? You know, and that's a decision that I'm working with a lot of small employers on. You know, are you going to continue with this plan? What's the best thing for you and your employees and your company? And then the next question is, if they don't, you know, if they have something, there is something that's being implemented, where they call it the early renewal strategy where
A lot of the health plans your individual plan and small group plans are going to renew through as a grandfathered plans through 2014. So that's kind of a benefit so that people don't have to rush and make a decision by January one they can actually grandfather their plan in which is sort of comforting to thing. Just think of the you don't have to rush into a decision, oh, I've got a year to make a decision. Yeah. And it's, that's nice to know you have that option. And then but if you'd work for a company that says no, we're gonna drop it, you know, we're gonna pay the penalty, or no, we're not going to do this, then the next thing is that you're going to want to talk to an agent or navigator is that's another term that they've come up with, that can help them understand seems like an appropriate term, because navigating these waters is gonna claim specialists. Yeah, I mean, it's really gonna take somebody knows what they're doing. So let's talk about HSA plans. Okay, so health savings accounts, those have become much more popular, at least from the clients that I work with and talk to, and you know, I get to know people's financial situation in the mortgage world a little bit.
And, in fact, that's the insurance coverage that I have now as an HSA plan. Tell me a little bit about how HSA plans are going to work underneath this new structure. So health savings account, you put some money aside, your premiums are a little less, and then you can take money out that you've saved to pay your, your deductible, or to pay your other medical expenses, and it becomes tax deductible. So it's, it's good from a tax perspective. And what I found as an individual for my families was less expensive. Yeah, as insurance options. So how's that going to change? Or is that going to change, I love the concept of an HSA. And that that concept actually has been around for a long time, large companies use it, and they call it self insured. And that's basically what you're doing, you're self insuring your family up to your deductible, and it could be a 2000 or a $10,000 deductible. And, and I like I said, you pay for everything up to your deductible, including prescriptions and doctor visits. I like the idea because you're going to control those first dollars out now, maybe 10,000 is too much for you. But maybe 2000 is something you can handle. So there's a lot of a lot of people who've got on board with them because they like him and the premiums low in ways that is lower because of that because people are less likely to go and do things because they're bearing the full expense of that first set of dollars. Yeah, so boy must be needed, we're gonna hold off. It's the nickel and dimes theory that when, when the health insurance companies have been nickeled and dimed for little doctor visits, because Susie had a cold, or even prescriptions, prescriptions are so expensive. And if you're willing to pay the first $2,000, your prescriptions that could come down to get a prescription that you don't need, right, you're not going to get more than you need, when you're paying for it out of pocket. You're not billing your health insurance company. So I love the concept I actually, you know, the, the capitalist in me says that that would have worked. If everyone had an HSA, this could really helped a lot of these issues. So there is some confusion. I think there's some myths out there that you know, the HSA is are going to change. So
a lot of them, there are some things it's going to be interesting to see. And we're not quite sure, because they haven't rolled out these plans yet. But under the new federal exchange plans, they have to cover maternity. And right now each state is not covered. So they haven't rolled these out yet. So I'm kind of interested to see how they're going to roll them out. But that's got to have some some significant impact on the premium cost. Yeah, when you add that in, because clearly always in Utah, maternity is kind of like the always everybody needs it. Yeah, it's hard to get because it's expensive, because everybody uses it. Yeah. You know, that's gonna have an impact on premiums across the board. Yeah. And we are in your analogy of How old is your car? And is it smoking? If that determines your premium? Right? You've got to assume that the insurance companies are going to go with the the highest reasonable premium they can, so that they make sure that they're not losing money hand over fist? Sure, there's going to be some economics to it, they're going to try to figure out what the market can bear to but they'll Yeah, it's going to be real interesting to see now they had to the health insurance companies had to post their premiums by the end of last month, but I think I read somewhere they got an extra month to do that. So we're really excited to see how it's gonna change. But another another 45 days, you should be able to sit down with health insurance specialist, somebody should be able to call you up and say, Tim, what's my options for next year's insurance? And you can go through and give them a pretty good idea. Is that hoping though the thing that could happen? Again? Yeah, the other thing that could happen is they may not say anything till October one, because they don't want us to they don't want us talking about it. I gotcha. So I don't know. I'm hoping we know sooner. We had a really busy October. Yeah, I think Christmas is out. That's Christmas. My kids are Christmas is canceled. Yeah. Wow. So if you have an HSA plan, this is definitely something you need to keep an eye on and get yourself educated. Yeah, because there could be some changes. At the very least it sounds like there's gonna be some significant change to premium. Now when you're dealing with somebody who's self employed, a lot of our listeners are self employed on small businesses or work as independent contractors. We are dealing with somebody who's self employed, how is that exchange going to be?
impacted? Is that the same type of a math for the calculation of whether they qualify for those subsidies you were talking about? Or how does a self employed individual deal with it? Or is it the same way as somebody who's getting a W two? You mean somebody that's like a, like a sole proprietor and one provider, they own a business, maybe they're a contractor? Or maybe they own a small business with a couple of employees? Yeah, how does that impact them? And here's one thing that's actually going to I read an article yesterday where this could solve a problem. There's a lot of people that work for corporate America, and they'd say, Man, I would love to just break away and do my own thing. Yeah. And they're afraid because their wife has diabetes. Yeah. And so they not want any work, they can't get insurance for his wife. So he's, I mean, there are people that literally work for a company because of the health insurance done, I go multiple exams with people, I know where they stay there, and a job they hate, or that's not paying him great, because they've got insurance, they don't want to risk it. And I read an article yesterday where that could go away, people can now say, what I don't need to continue to work for XYZ Corporation, because now I can go get my own health insurance. And I cannot be denied no federal exchanges available for self employed individuals, well, they'll just go on as an as an individual. So I, you know, and again, theoretically, this sounds like, and I can see what the good sale points are here, honestly, what you just mentioned is a big one, you know, portability of insurance, the idea that you can get insurance outside of an employer plan that, you know, these pre existing conditions don't preempt you from getting insurance, the flip side of this being, someone's gonna have to bear the cost, right. And nobody really knows who that's going to be other than, you know, rightfully, somehow magically, the economy will cure itself, we'll all have more money and more more pay more taxes, but reality being it's going to be result and right, even more deficit spending. And eventually, major massive tax increases somewhere Yeah, to cover this bill, or, like our earlier caller alluded to a decrease in options and services and availability. Because when you look at you know, when a doctor's office as well, we've got to buy this new piece of equipment or this new machine, and it's going to give us the ability to give better care, but we're not going to get reimbursed for it. So we're not going to do it. Or if we are going to do it, we are going to use this particular laser treatment for cancer, whatever it might be, it's going to be a cash only deal could be. Are you seeing that? What are the rumblings about that? And yeah, there's some talk about,
about cash paying medical care. Instead of using insurance. There's talk of like, companies coming in and buying hospitals and being cash only hospitals and you know, it, this is America, and we were founded upon capitalism, and if that's the direction the market goes, that's the way it goes. So the unintended or, depending on how cynical you are, the intended consequences of this could be a real segregation economically of our healthcare. And you know, personally, I'm torn because I could see where health insurance really helps so many people but on the other end, I wonder how we're gonna afford this as a country, how it's going to work out. Alright, well, we'll be back after the break with any questions you've got you still got a chance give Tim a call. 801-718-0051 is his cell phone number. Call us today. 812545855 this morning here at the studio ask us your question.
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Welcome back when Wall Street meets Main Street, this is your host Alan blood here with Tim Jackson from insurance specialists talking about your health insurance and your coverage. So Tim, just in closing here on the show today a couple of key questions I really want to cover so our listeners can be where someone who's got current insurance right now how does this impact their plan? Can they keep their plan? Is this going to change their plan? What does that do most
Companies small group individuals that have coverage through major carriers will be able to do this early renewal strategy on Blue Cross Humana IHC, or whatever it is, they're calling themselves each day. Yep, they'll be able to do the early renewal strategy. And they'll be able to grandfather their plan for a neck for another year. So they don't have to make a decision come 2014 although some will, I really believe that you should look at your options and leave that open. So you know what to do? For sure. your specific situation, it may very well make sense. Yes. If you qualify for some of these subsidies. Yeah. Look, go and look. Yeah, so you shouldn't? So would you say somebody ought to lock themselves in now? Where would your recommendation be? Give it a few months? I would, if people were thinking about getting insurance, I would look today, because that way, you at least have options come January one, you could keep your old plan. And maybe that's better. Or you can look at something new with the new affordable care act plans. Gotcha. So this is not a reason to sit to sit around and wait until the end of the year, you may be able to qualify lock in something that will be better than what you get that or at least know your options, understand what those might be. I will say I do use some strategies because some people say I can't get insurance, because I've been denied that there are some strategies that I'm using today that can help people bridge that time. So those who who feel like they couldn't get insurance. There's some ways to kind of navigate. There's the term navigator to navigate into some insurance today that may be one an existence before Yeah. Okay, well, that's good to know. So somebody hasn't gotten insurance, they really had to give you a call. Yes. So let's say someone opts out says, Well, I'm just not going to get insurance. Okay, I can't afford it. I don't want to I don't need it. Right, what are the individual or company penalties involved with opting out of health insurance? So they call this the individual mandate, okay. And, and it's the individual's responsibility to have it, it's kind of funny, they want to avoid the word penalty. But so in 2014, you would have a $95 annual
assessment, right? a mandate, fee, ie penalty, that's per person in your home. $95. Now, that's not a lot of money. For people, you're basically 400 bucks if you chose to not carry insurance, or 1% of income, whichever is higher. Oh, gotcha. So 1% of gross income. So your, your $62,000 there. $620. of the of an assessment. Yes. Okay. A mandate fee. Yeah. Now, one thing that I my neighbors used to say, Well, I know what I'm gonna do, I'm just going to pay the penalty. And then whenever I get sick, I'm gonna call you up on the way to the hospital, you're gonna sign me up with a plan? Because you have to say, Yes, well, they are going to have enrollment periods. Okay. So if you miss the enrollment period, you have to have a qualifying event to get on the plan. So much like I guess Medicare is you got enrollment periods, you try and eliminate the free rider. Right, right. You'll have to have a qualifying event yet on image it would be those activating events for the qualifying events is this Yeah, birth, death, divorce, loss of coverage. There's one other so just I didn't have insurance before, but now I think we're on it. Yes. That's that's something else. So that's good. I think that prevents this from being abused. Too often, how frequent are those enrollment periods? They come first year? Well, they're talking about doing annually. The first one will be on October one through the end of 2013. I've heard that they're going to do a second one in the summer, we don't know exactly when but there they will get to a point where there'll be one enrollment period like it is for Medicare. So similar to Medicare at the end of the year, you've got an enrollment period, you figure out what you're going to do, and then you're locked in for the next year. Yeah, barring some other qualifying event, which is fairly limited in its scope. Yeah. Okay, exactly. So I also want to say that penalty increases, though, okay, I was gonna say that. So that's got to go up from there. So 2015 is $325, or 2% of income, 2016 and $695, or two and a half percent income, and 2017, the penalty will be adjusted for inflation. So but basically, whatever they want, whatever they want, whatever they think they need to do to balance out this enormous deficit that this is going to create. Yeah. Bottom line being it's going to become, especially with some of these subsidies cheaper. For those who don't have to get insurance through these exchanges. Yeah.
So is that the argument here in favor this that people who are right now uninsured and are maybe going in and using the emergency rooms as their insurance methodology that this is going to force them into the insurance industry so that it helps to balance out the cost? Is that the idea?
In a tough question, because that First Citizens United States, yes, yeah. So this and this now, how does this apply to those who are not those who are here, either here without documentation, those who are not citizens that are not paying taxes that aren't involved in the taxes, right? Well, we show on that, but I'd have to say that that's going to be it's hard to pay her to have someone that's not assistant pay any penalties or fees, right. There's no methodology
here and they're going to use the emergency room as their as their medical care. That's not going to change. Yeah. So there's that
And there's a real hole that this plan leaves is a national budgeting plan. Okay, well that's interesting. So you mentioned the term earlier navigator Tell me about this navigator term. So the word navigator actually came up through this Affordable Care Act and there's two types of people that can get you insurance one is a broker like myself or a navigator and navigator This is a very controversial thing in my business and navigator is a someone who'll be able to help you understand which on a non bait on non bias level what plan is best for you and your family. The thing that's sort of controversial in my business is that this person doesn't have to be in licensed and so and it's can come from a nonprofit so an association can offer something like this Okay, you know I'm working with some chambers in offering something like this The difference is a broker cannot be a navigator Okay, so does a navigator get paid when they help people obtain insurance there are federal grants available to the navigators to help people I was watching the news this morning and I heard like 1.5 billion has been designated navigator grants basically to help them understand these sort of non licensed individuals are just organizations that are trained in operating computer software pretty much that are going to be absolutely ensuring business yet read the screen and help them understand so if your situations as you know easy we're a navigator can help you it's probably a great idea is that is there going to be a cost differential between going to navigate our broker I mean, it's gonna be the exact same practice same thing Yeah. So so the navigator is basically going to be a non licensed not necessarily trader certified individual
that's going to basically read through a computer screen with you yeah, I think whereas a broker you're going to be giving the exact same cost, right? Yeah, I mean, they're not going to pay more because you know more they're gonna write the exact same they're just gonna get more service. Yep, exactly. And and for some people that aggregator is going to be a good thing but for for others maybe the middle a little more complex and may want to talk to a broker who's had experience in industry for a while it would seem like this leaves a big hole open for trade associations are like you'd mentioned chambers who are saying boy we need another revenue stream for our association or our organization. Yeah, we're gonna become an insurance navigator it could and which may or may not be beneficial to their members because you know, great maybe they're giving you information that's correct. Maybe they're not because they're not like you mentioned we're in a free market. Those who are getting paid tend to get paid for reason those who aren't tend to not get paid for reason. And usually that reason is because either they're committing fraud, they're cheating people or because they know what they're doing and they're earning their money. Yeah, hopefully there's more of the second less of the first so it would seem to me like the wisest decision for most people would be to call a broker and say what can you do even if they are gonna speak with one of these navigators? Yeah, all right. That's that's very biased in my hand. I'm sure it is. But you know, I'm not I'm neither one but it seems like that would be a more wise solution to deal with somebody who's got more expertise training and a license on the line if they give you bad information rather than just somebody's gonna say Oops, sorry, my bad and move on to the next person that can help navigate through this mess. So parting words what's the what's the stuff you want people to remember what the takeaway you want everybody listening to know after listening today, not to be so scared about it, even though it's huge. And there's a massive things that are changing. Just Just know that if you have a health plan now, you can grandfather that into next year. And then also that others be good options for people. I think this could be a very good thing. Okay, great. Well, if you've got questions, you want to get ahold of Tim, give us a call here. We'll guide you to him, or you can find him at t Jackson, at my health insurance. specialists.com go there, check him out or go to his website. Go online or go to his email, voicemail. Sorry, 801-718-0051. Tim, what's your website? My health insurance specialists calm my health insurance specialists.com go check him out. You really got to have a conversation with him. It'll be of good service to stay tuned. Thanks, Tim.
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