ObamaCare and Class Warfare

I read the news everyday, and there are always quotes detailing how the rich are taking/getting more than their share.  There is no doubt that people with money have more (of everything) than people without.  The beautiful thing about this country (U.S.A) is that we ALL have the opportunity to better ourselves, and succeed beyond our wildest imagination.  It wasn't until the 1920's that Americans really started recieving "things" from their friendly, altruistic government, and it wasn't until decades later that Americans expected these "things".  Prior to that, charities did a fair job of caring for the underprivileged and needy.  At that time, the "hand up" mentality was more common than the "hand out" mentality.  Charity and community were the orders of the day for those that needed it most.  The fact is that "rich" people can afford to equip themselves better than "poor" people because they have done the things necessary to make the money that they have. In spite of the government's best efforts to help the less fortunate: free food, housing, healthcare, college, business grants....etc., there is still a large segment of the population that remains (and will always remain) impoverished.  It makes you wonder who is actually benefitting from these "freebies".  There is a quote that was uttered a long time ago, but has never been truer than it is today,

 "If you rob Peter to pay Paul, Paul will always support the guy that is robbing Peter".

Enter ObamaCare.  There was a great survey on squidoo.com (http://www.squidoo.com/Obamas-Health-Care-Plan-Poll).  The survey has a nice "schmere" of questions, but the this part is what prompted this blog:

Now everyone will be able to get the care they need instead of only the wealthy

This implies that people without money have been going without care.  There are some cases where this is true, but the lions share of people without money (that have a health need), get treated.  There is no question that money will get you better care, and that will always be the case.  The question isn't "should the poor and sick get the care that they need"?  The first question that we should ask is "should the federal gov't be involved in healthcare"?  If we answer "yes" to that question, the next question is "how?".  There are essentially two options. 

1. Create a massive beauracracy to dictate who/how/when/what type of care is recieved; and maybe even provide said care
• this promotes the idea of "Paul" voting for the guy robbing "Peter"
2. Provide tax incentives to any organization that would like to provide/support charity care to the people that needed it most.
• this doesn't promote any voting block...just better care for those in need.

This is not an anti ObamaCare rant.  It is more of a frustration about the lack of personal responsibility and pride that plagues many Americans today.  I am not saying that being successful, or making more money is easy, but in this country anything is possible.  There is no shortage of people/organizations willing to help anyone to learn a new skill/trade to better themselves.  Here is an idea,  help yourself.  Go to the library...it is free.  Read a book, watch a how to video, apply yourself, and attain a goal. 

The problem isn't the system, it is what the system has done to a good portion of the population, and how it has shaped their views about themselves and their abilities to succeed.  The "teach a man to fish" parable comes to mind. 

Opinions, Comments and thoughts are appreciated.

If you would like to contact me directly: tuzzell@insphereis.com

Long Term Care...The Rest of the Story

Long Term Care Insurance is quite possibly the most underutilized insurance product with the best bang for the buck on the market today.  Before we get into the dollars and cents, let me paraphrase a definition.  Long Term Care can take on many forms: skilled nursing, assited living, nursing home, in home aid, certified family member looking after you.  The way that insurance companies define it is where the rubber meets the road.  A couple of months ago, a rep. from a major LTC insurance provider stated that if a person is unable to perform at least two ADL's (activities of daily living) then they can make a claim on their LTC policy.  ADL's are common things.  I am sure that if you gave it just a little thought, you could come up with a handful of people in your inner circle that could have used this type of insurance (after car accident, stroke, surgery...).  The thing that most folks don't understand about making a claim is that it doesn't have to be for forever.  If you just needed aid for a couple of months, that would be an option, and after said care was rendered, the policy would still be in force;  now that's insurance.

Now lets talk dollars.  As I said, LTC can cover many types of care:  skilled nursing ($100-300/day), assisted living ($1000/month and up), nursing home ($2000/month and up), in home aid (20/hr and up), and a family member (certified ) caring for you (whatever they want to charge).  There are other types of covered care, but this is a decent list.  The dollar amounts noted are empirical to my experiences in Arizona.  In my opinion, LTC insurance is cool because you could use in the event that you needed it when you are young, but the vast majority of people will require some form of long term care when they get older.

A good example is a 70 year old woman that needs more care than her family can handle.  She would be well served to get into an assisted living facility.  For this example let assume that they wanted a very nice facility where meals were provided, and there were nurses on staff at all times.  This might cost around $3000-$4000 per month.  If they didn't have an LTC policy in place, she, or her family would be on the hook for about $50,000/year.  This lady wasn't sick, just needed some care.  Grandma might live to be 85 or 90.  The costs of this facility could definitely add up.  If the funds dried up, she would have to change facilities, or rely on Medicaid to foot the bill (at a Medicaid approved facility).  If she had Long Term Care Insurance, a pool of money would have been growing (tax free) since the day of inception.  I could go on and on about how much money she would have had, and saved, with a little forethought.

Scenarios like these are endless, and each situation is different.  The best way to get into one of these plans is at a young age.  This will allow you to take advantage of time, and truly grow a vast pool of money that you can use when the time comes.  As modern medicine continues to improve, life expectancy increases.  The fact is, for 60% (or more) of us, the day that we need long term care will come.

Opinions, Comments and Thoughts are appreciated



For a quote, contact me at www.insphereis.com/tuzzell



http://www.squidoo.com/longtermcare
http://www.consumerinsuranceguide.com/long_term_care_insurance/long-term-care-insurance-is-more-than-nursing-home-care/
http://www.seacoastonline.com/articles/20130303-LIFE-303030324

10 Things to consider before buying Health Insurance

I thought that a list would be pertainant to help you navigate through the confusing world of health insurance.  There are a lot of things to think about when deciding on an insurance plan.  It is important to find a carrier and design a plan that fits the needs of you and your family because, if something medical happens in the future, this could be your health plan for life.  With that in mind, lets get started.

1. Have a budget in mind +Ashley Barnett 
• This might be the most important piece to the puzzle.  If you don't know what you can afford to set aside to protect your family then this is a difficult discussion to have.
2. Be prepared to discuss your medical history.
• I know that this is private, but there is no way around it.  If you don't feel comfortable enough with the agent to talk about yourself, then you might need a new agent.  There is no real way to hide any diagnosed condition from the health insurance provider; they do their due diligence.
3. Understand MOOP (maximum out of pocket)
• This is super important...Each health plan is a little different.  The MOOP is the most that you would have to come out of pocket before the insurance company will cover you 100%.  The math goes like this: deductable + coinsurance (if you have one).  There are specific rules that apply to families in order to make the worst case scenario more manageable. 
4. Will you need prescription benefits
• This is one of the catch 22's of the initial application process.  You may not have a need now, but if you elect to have no Rx benefit at the beginning, it is very difficult to add in later.  Some prescriptions can get prohibitively expensive.
5. What is your comfort level regarding deductable and coinsurance
• Many people that have had a group plan in the past are used to having low deductables ($1000-2500).  In the individual health insurance market, the relationship of deductable to premium is very evident.  If you like the idea of a high monthly premium for a deductable that you hopefully will never reach, then be my guest.  If not, design a plan with a higher deductable, and utilize all of the products that the market has to offer to keep your money in your pocket until you really need it.
6. Is your preferred doctor in the network
• If you have a doctor that you like, this is a deal breaker.
7. If you travel alot, this is important
• If you do any travelling, understand what kind of network your health insurance plan has.  Being out of town, and out of network can turn a nice vacation into a nice bankrupcy.
8. Is dental or vision insurance a concern
• These are insurance policies that many peoplel hold dear to their heart.  Plans for these types of coverages vary, so read the fine print.
9. Having supplemental insurance will limit exposure
• The idea of supplemental insurance has been around for long time.  As health insurance costs continue to rise, the popularity of these cash payout policies is on the rise.  Many people use these as a hedge against a higher deductable in order to maximize their protection and keep their premiums down.
10. Find a knowledgeable agent to guide you through the process
• Having someone that understands the market, the available products, and that can disseminate all of that information to you in simple terms is priceless.

I hope that you feel more prepared to delve into the world of health insurance.  If you have any questions, my contact info is below.  Feel free to use it.

Opinions, Thoughts, and Comments are always appreciated.

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Are You Prepared??

Door of the Unknown

Preparation?  This means something different to everyone.  Some people don't like to plan and prepare, some can't do anything without a plan.  The fact is that life is full of unforeseen events.  While we can't plan for things that we don't know about, we can be prepared.  Here is a fascinating quote from a movie that I think is pertainent, "chance favors the prepared mind".  This just means that if you are prepared, the results of the unknown can be more easily dealt with.  Enter insurance, specifically health and life.  These two insurance products are the epitomy of preparedness.  In my daily interactions with people, I have met many that don't have either one of these two pillars of insurance.  Some of them can't afford it, don't want it, or don't think that they need it.  You could make an argument for any of these reasons, but at the end of the day, responsibility is the order of the day.  "Are you acting in a responsible manner?"  This question is posed on a personal level as well as on the bigger scale (your fellow man).  I am not going to get into the responsibility side of this industry...not today. 

 Let say that you are supremely prepared.  You have health, life, disability, long term care, and all aspects of your property and casualty covered.  At this point, I would probably get you a hug and a high five.  The next question is," do you have enough coverage?  I know that this sounds like another sales pitch, but coverage is relative.  If you have a mansion, six cars, and a million dollars in the bank, you need a different amount of coverage that a standard middle class family with a house, 1.5 kids, two cars and a dog.  This seems obvious, but trust me, it isn't.  An example of this that I run into everyday is people that have health insurance, and honestly believe that they are "covered.  When I ask if they are prepared to spend their savings to support their family in the event of a catastrophic event, they don't look so prepared.  While traditional health insurance is great, it doesn't help you or your family in times of emergency.  It is designed to pay the doctors and hospitals for your care.  If you have a medical emergency, there is a good likelihood that you will be unable to work, or complete your daily tasks for a length of time.  It is for this reason that supplemental cash insurance was created.  These policies cover the person where traditional health insurance covers the doctors and hospitals.  It is hard to truly be covered without these personal coverages supplementing your health insurance.  The truth is that if you are "underinsured", then you are not adequately prepared. 

 

The key is to have a plan in place to make sure that you are prepared for any event that can come your way.  Being prepared doesn't mean that a bad situation won't suck.  It just means that it won't be so life changing for you and your family that you won't be able to bounce back from it and essentially cease to exist in the manner that you have been.  When disater/emergency strikes, it is nice to have family or friends to help.  But the fact is that you are the one that is responsible for you,  not anyone else.  This is a concept that seems to be dying more each day.  In times of need, pointing fingers and blaming won't fix the problems that preparation would have.When someone you know, or even you (God forbid) is strickened with cancer, heart attack, or a major accident; who will pay the bills?  The prepared person would have a list of companies and resources to give as an answer to that question.  The unprepared person doesn't have any answers.  Which one are you???



Opinions, thought and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Are You being "sold", or Are You BUYING?

Everyone hates to be "sold".   There is no doubt that if you walk out of a purchase wondering what just happened, it is a big thumbs down.  The fact is that if the sales person doesn't sell you something, then they don't get paid.  The even bigger picture fact is that if you get "sold", then you are not ever going to buy from that sales person again.  The grey area comes when you have a need (not a want, like a TV or new purse).  When we are looking for something that we need, we often will buy based on that need instead of making sure that what we are buying is the best purchase for our dollars.  Insurance is that kind of purchase.
As a consumer, it is imperative for us to search out the most knowledgable people to help us make the decision that is in our best interest. With the popularity and ease of the internet, we often look that way for answers.  The truth is, the internet offers us limitless information, but little direction.

There are some decisions that are pivotal inspite of how simple the process may seem.  Making the wrong decision for your insurance needs can be devastating.  If you don't understand what each product can and can't do for you before you buy, then how can you make an educated buying decision?  The worst part of the whole thing is that if you have a major health event, you may never be able to change the insurance that you went online and clicked a few buttons to purchase.  I know that our time is precious, and giving up just a few minutes seems like a jaw dropping experience.  But if you don't find out everything that you need to know, it could be a life altering choice.

 

Once you have taken the time to educate yourself on all of your options, then you are ready to "not be sold".  The educated consumer is a buyer.  When you are making a decision with all of the facts in hand, you will be comfortable and happy with anything that you choose to buy.  Insurance is a highly regulated business with many moving parts, find a licensed professional to help you navigate through the minutia.

Opinions, thought and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

The 5 Pillars of Insurance

I spoke with someone today that called insurance a "necessary evil".  I had no argument.  Insurance is a double edged sword.  It is something that you never want to use.  If you do need it, you want to have the best available; and you want to pay as little as possible for it.  It truly is a tangled situation. 

For this installment, lets agree that insurance is a need.  With that in mind, I put insurance in five catagories:  Property and Casualty (P&C), Health, Life, Disability, Long Term Care.  The question is, "what do all of these have in common"?  The answer is, "risk management".  In an earlier blog, I talked about limiting exposure as it pertained to health insurance.  The truth is that when managing risk, limiting exposure is the name of the game, and each of these products addresses that in their own way. 

Property and Casualty

This is not my speciality, but I'll tell you what I know.  P&C is an all incompassing field.  This covers your house, car, business, and anything else that you own.  This is the only "head of the monster" that covers your "stuff".  In the process of covering your "stuff", it provides indirect asset protection.  Whether you have assets or not, having your "stuff" insured will help you to replace it in the event of catastrophy.  There are also personal coverages built into P&C coverages.  For instance, if an injury occurs in a house or business, it is often possible to make a claim against the home or business insurance for the medical expenses incurred from said event.  If you get into a car accident, there are protections built in to cover the medical necessities of the injured as well.  Over the years (and many law suits), the Property and Casualty coverages have gotten pretty comprehensive.  As with any insurance, more coverage = more cost. 

Health Insurance

This is the insurance that most people know they should have.  The truth is, if you get sick and go to the hospital, you will get fixed.  You will leave the hospital with a bill, and you can pay it at your leisure (not exactly, but there are restrictions on how hospitals collect money).  The idea behind health insurance is to protect you from major medical bills.  It is not for regular check ups, or generic prescription drugs.  Many people have gotten spoiled with their group plans at their jobs.  These plans generally have a low deductable, and they cover almost everything.  The reality is that health insurance wasn't designed to cover everything that could go wrong with you. 

As the definition of health insurance changes, expectations of coverages vs. costs must change too.  The future of health insurance in America will be high deductables combined with supplemental cash benefits.  This combination will allow consumers to keep costs down, and give them the coverage that they need in case of calamity.  We will also see growth in the defined benefit plans.  The market will design plans that are advantageous to the consumer if it is allowed to.


Life Insurance

Life Insurance is the only policy that is guaranteed to pay out.  The downside is, you have to die to get it.  This insurance has many purposes.  Young people have it to provide for their family in case they die unexpectedly.  Older people have it to leave something to their family when they die.  In both cases, it can be used to cover debts and final expenses.  There are many ways to structure a life insurance policy.  Some people prefer term insurance, and some prefer permanent insurance.  Each of them are valuable, and can be used together very effectively.  With the tax structure ever changing (higher taxes), the life policy is one of the last places to get tax free growth.  It is the only place (that I know of) that you get tax free growth and can remove the money (for any reason) and not pay taxes on it.  Life insurance products are becoming more popular by the day.  There are many types of permanant life products (whole, indexed, variable indexed, universal indexed).  Most of them allow the client to take advantage of the growth in the market without any risk of losing their money.  Wealthy people have been growing their money in life products for years, but this is available to anyone.  With the combination of asset protection and immediate estate formation, having life insurance should be a no brainer.

Disability Insurance

Another way to say this is, "income insurance".  We protect our home, car, health, and wealth.  Why wouldn't we protect our income.  There are many misnomers about disability insurance.  The first is that you must be disabled to make a claim.  The main criteria for making a claim is for a doctor to certify that you cannot do your job.  Once that is determined, you can make a disabilty claim.  It doesn't mean that you can't earn money, it just means that the injury restricts you from completing your daily tasks (and others like it).  The second myth is that disability is prohibitively expensive.  There are a myriad of factors in determining the premium: type of profession, income, current health, duration of benefit, and many others.  When you look at the benefit vs. the premium, it typically doesn't seem very expensive at all.  The main function of disability insurance is income protection. 

Long Term Care Insurance

Over 50% of Americans will use some sort of long term care in their lifetime.  The percentages increase with age.  Most people think of this insurance being used for nursing homes, and in home care for the elderly.  These are two of the reasons people utilize long term care insurance, but it goes much further than that.  If you have a long term care policy in place, you can make a claim on it if you lose just two activities of daily living (ie: eating, bathing, dressing, toileting, transferring (walking) and continence), regardless of age.  It is easy to see how the loss of a couple of these abilities could occur (accident, sickness,.....).  LTC insurance offer a great value to the policy holder, and if it is started early, the value is much more robust.  LTC policies give the client a pool of money that is available from the first day that the policy is in force.  They can be designed to grow at an agreed upon percentage (2-5% usually).  Over time the original pool can get much larger, and is at the clients' disposal (once a claim is made) until the pool of money is exhausted.  Skilled nursing care is not cheap, so a larger pool of money is desired. The main function of LTC insurance is asset protection. 

If you put all five of these products together, it is easy to see how each pillar has a place and function.  If you don't have each one of these in place, make a plan to do so.  We don't all have enough money to have complete protection today, but with a solid plan in place it can be done. 

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Obama Care...the first shoe drops

The Affordable Care Act, a.k.a Obama Care has been a point of contention since its inception.  It was promoted as the answer to all of our healthcare woes, and we are quickly finding that not to be the case.  Regardless of where you stand, there are some undeniable truths. 

There are a few good things that have come from this legislation.  One of them is that there are no more lifetime limits in health care plans (you cannot exhaust your plan with high cost procedures).  Another benefit is that kids cannot be declined from their parents' plan (but the insurance company can charge more for "sick" kids).  The last major benefit that came along with the ACA is that all preventative care is covered %100 (wellness visits, shots, breast exams, colonoscopies, etc..)  The administration aportioned funds to each state to offer plans to people with pre existing conditions called the PCIP plan.  These plans provide quality coverage adn the premiums are based on age alone.  While these changes are good for the consumer on one hand, they are not free, and the additional funds must come from somewhere.

One way that the gov't decided to help pay for these benefits is with the 85/15 rule (this rule varies from state to state and by size of provider).  This rule states that health insurance providers must use 85% of premiums collected for medical claims, leaving 15% for administrative costs, commissions, and other non medical requirements.  As the new "guaranteed issue" products become available we will see taxes change, and overall costs rise. 

Now for the consequenses that I have seen thus far.  The first effect that is painfully evident is that the health insurance companies are tightening restrictions for new applicants in an attempt to build healthy books of business prior to the "guaranteed issue" products.  These underwriting guidelines have forced more people into the state plans (PCIP), which is why they were formed in the first place.  The latest word from the state of AZ is that they are suspending new applicants to the PCIP program due to budget concerns.  The big question is, "where do the sick people go now?"   The answer is to the emergency room...higher costs for the rest of us.   And this is just the beginning.


Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Life Insurance. Want it? Need it? Who Cares?

Life insurance is probably one of the most underutilized and misunderstood products on the market today.  It seems like most people know that they should have it, and might even want it, but getting it is often a whole different story.

Lets start with the purpose of life insurance.  The most common reason is to pay for debts or things that people were planning to pay for prior to an untimely demise.  This site offers a plethora of reasons to have life insurance (http://www.dfs.ny.gov/consumer/cli_analy.htm).  The cool thing about life insurance is that you don't have to have alot of money to have coverage.  It is only product available that creates an instant estate once a policy is issued.  As with any financial product, planning is highly important, and the longer one waits to get it, the more expensive it becomes.  A wise man once told me that you buy life insurance with your health, not your wealth.  What makes this true is that once you are sick (depending on the severity of the illness), life insurance is out of the question (most companies don't like to buy claims for sick people).  On the flip side, if you are young and healthy, life insurance is cheap, and easy to get. 

We have established that having life insurance can provide a legacy for anyone that has a policy.  From the poorest pauper to the richest billionaire, as long as the premiums are paid, a claim can be made and paid to beneficiaries.....Legacy.  The beautiful thing about life policy benefits is that they are paid tax free to the beneficiaries.  This is not a blog about tax free growth, but life policies can do some interesting things (a future blog). 

 

This is where the wheels can come off the train. Term vs. Permanent insurance.  There are many schools of thought when it comes to this argument.  Some people are very opinionated in there beliefs in one or the other.  The angry people typically support the Suze Orman/Dave Ramsey approach....Buy term and invest the rest +Ashley Barnett .  The people that believe in permanent life (whole or universal) like the idea of growing cash in a life vehicle, getting a decent rate of growth, and doing it in a tax free manner.  I could do a whole article on each of these.  I believe that there is a good use for both of these products, and they are often best used in conjunction       with eachother. 

 

I haven't even scratched the surface.  Life insurance is underutilized because it can be used for multiple purposes:  retirement, college fund, protection against untimely death, hedge against taxes (always going up), and peace of mind.  It is misunderstood because many of the people that know that they need it don't know why, or how to use it when they get it.  This is just another example demonstrating the need for a competant agent to help guide folks through this decision making process.  The main mistake that almost everyone makes is in estmating how much insurance they actually need.  This calculator from ING helps with that (http://ing.us/employers/employee-benefits/products-services/life-insurance-add/life-insurance-calculator).  The results are astounding. 

 

As to the initial question, Want it? Need it? Who Cares?

 

People that want it don't know how to get it (or how affordable it can be).  Everyone needs it.  Who cares is the real question.  A career life insurance agent told me "the only people that don't need life insurance are people that don't love anyone".  I don't know if he was joking, and I'm not sure how I feel about it, but it speaks to the reason that anyone would get life insurance: for the ones left behind.

 

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

The "Uninsurables"

Anyone with "pre existing conditions" has heard this term before.  There are many reasons that Insurance companies decline potential clients.  They range from pre existing conditions, expensive prescriptions, to dangerous lifestyles.  I happen to believe that some people get declined because that underwriter was having a bad day (purely conjecture).  There are some scenarios in which "uninsured" folks can get insurance, but the insurance company will place a rider (refusal to cover) on the very condition that the client wanted the insurance for.  The purpose of this article is to detail the different options that "uninsurable" people have today, and will have going forward. 

There are many options for people that cannot get a traditional major medical.  Each state offers a plan that everyone qualifies for (provided they have been declined from a traditional insurance company), but it is not free.  There are a number of companies that offer indemnity plans, or plans that define the maximum benefit (limit the maximum amount of coverage provided).  Another option for these people is a membership to various associations that provide a myriad of discounts/benefits.  Some folks elect to do apply for cash payout policies (the client recieves cash for accidents, illness, or injury).  There is one more program that is offered through the state that is reserved for people the fit into the "low income" category, and there no underwriting requirments (other than being poor). 

I will go into a little more detail on the programs that I outlined above. 

There are two major plans that are run by the state (in AZ).  The AZAHCCS (often called "access") http://www.azahcccs.gov/Default.aspx is the program that is based on income.  There are a number of subgroups under the "access" umbrella, but the takeaway is that it is for "low income" earners.  These programs are becoming more difficult to qualify for due to the increasing amount of applicants.  As far as the plans go, they are very good.  There are some restrictions regarding doctor choice, but the overall care is comprehensive.  The bottom line is if you are poor enough, you can get free insurance (thank your neighbors...).  The other plan offered by the state is call the PCIP plan, https://pcip.gov/.  This plan is available to all persons with pre existing conditions that have not been insured for at least 6 months, and have been declined from one or more insurance companies.  This plan does cost money.  The monthly premium is based on a persons' age.  The coverage offered in this plan is comparable to a traditional individual plan, and quite affordable. 

I won't dive too heavily into the indemnity plans.  The short story is that there are a number of companies that offer plans that put a cap on the benefits available to their clients.  These plans have their place at the health insurance table.  By limiting the amount paid out, the insurance companies can make premiums more manageable for the consumer.  As ObamaCare nears, these types of plans will grow in number in an effort to offer "us" more affordable options.

The next option for the "uninsurables" is memberships to various associations.  There are many nonprofit organizations that offer discounts (often medically centered) for everything from doctor/hospital visits, to prescriptions, to roadside assitance, and even movie tickets and groceries.  These associations are great for the person that is willing to take on some risk regarding their health care costs, or just wants additional coverage to bolster their existing plan.  One example of this type of association can be found at www.affordableservices.org.  Like I said, there is no shortage of groups with discount packages to help the consumer in their quest for better coverage. 

The final option that I detailed is the cash payout policies.  These policies are truly personal coverage. Many people elect to use these policies to improve their overall coverage.  They don't offer any doctor copays, or any other "doctor" centered options.  They are designed to put cash in the pocket of the person in need when an accident or major illness occurs.  It gives the consumer a certain amount of control over their healthcare options when disaster strikes.  The fact is that if you get injured or sick, the hospital/doctors will fix you , and bill you later.  Once you have recovered from your afflication, you can figure out how to cover said bills.  This alone is not the most responsible plan for health coverage, but if you are "uninsurable", or just want to have some personal coverage, it is a decent option.  Some of the major companies that offer these coverages are Aflac, and Surebridge (http://www.surebridgeinsurance.com/).  There are others, but these are the major players in the personal coverage game. 

I am sure that there are other options for the "Uninsurables", but I just wanted to hit the high points to give a better understanding of the situation.  When the Affordable Care Act comes to fruition (October 2013), the idea of being "uninsurable" will be a thing of the past.  The new question will be "how can we afford this".  Time will tell.

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Health Insurance....The Basics

In this post, I will talk about some of the definitions that come up in every conversation regarding health insurance.  For instance, premium, deductable, coinsurance, copay, max out of pocket, in network, out of network.  The list could go on and on, but this is a start.  This might seem a little dull, but I will jazz it up.

I don't expect you to think insurance is cool like I do, but you will know more at the end than you did at the beginning.

Don't be like this guy. 

Premium:  the amount that you pay every month.  This number is affected by many things:  health rating, deductable and coinsurance.  Premium is directly related to deductable and coinsurance.  It is all about risk.  More risk for the insurance company = more premium for you.  If you take on more risk (higher deductable), your premium will decrease.

Deductable:  the amount of money that you are responsible for (to pay out of your pocket) before the insurance company takes full responsibility for any remaining medical bills.  Deductables are calculated on an annual basis, and reset at the beginning of each year.  Deductables currently range from $500 to $12500 per year.  Look for the insurance companies to offer higher deductables in response to the Affordable Care Act (Obamacare).

Coinsurance:  an option that can be selected in order to help lower monthly premiums.  These are dollars that you would owe in addition to the deductable.  Once the deductable is paid, the remaining medical bills would be split between you and the insurance company.  Every company offers different splitting options:  50/50, 60/40, 70/30, 80/20.  Under these scenarios, the insurance company would cover the larger portion of the bill, and you would be on the hook for the rest.  For example: a $20000 bill (amount remaining after your deductable has been satisfied) with an 80/20 plan... the ins company would pay $16k, and you would owe $4k.  Almost all coinsurances have a coinsurance max.  This places a cap on the amount that you would owe in any calender year.  ie: coinsurance max of $5000.  You would pay your deductable, then up to $5000 for your coinsurance, finally, the insurance company would cover the remaining medical bills for the rest of the year. 

head spinning yet?







Copay:  a fixed amount for services rendered.  ie: doctor copay ($35), specialist ($50), ER copay ($100), you get the idea.  Every insurance company utilizes copays differently.  This is a major component for some consumers to have in there health plan.

Max out of Pocket (MOOP): the most that you will have to pay in any calender year.  The deductable plus any coinsurance = MOOP.

In Network: insurance companies negotiate rates (with doctors and hospitals) for all services that they are willing to cover.  All docs and hosptials that accept the negotiated rates are "in network".   Typically, the insurance company with the most clients will have the largest network, and the lowest negotiated rates.  You will pay the negotiated rate for any service that doesn't have a copay, and that is covered by the insurance company.

Out of Network: doctors are not required to be "in network" with any insurance company.  When you utilize a doctor, or service that is not in your insurance company's network, the costs are much higher.  The deductable limits do not apply to out of network services.  Every company has different rules regarding out of network costs, and understanding them is a must.  The bottom line is that being a client of a company with a large network is a great benefit.

I have just scratched the surface of the ins and outs of the health insurance game, but I hope that you are smarter than you were when you started. 

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

people that have I have recently learned something from:  +Enoch Simmons , +ethanpajak@yahoo.com 

Limiting exposure is the name of the game.

There are many ways that people look at insurance, and I would like to offer my perspective.  All insurance is designed to offer some sort of asset protection.  Auto, home, life, health, long term care;  all of these protect us from becoming bankrupt in the event of a catastrophy.  A little known fact is that 60% of all medical bankrupcies are experienced by people that have health insurance.  This is where education comes in.  Regardless of how robust your health insurance policy is, it is designed to make sure the doctor/hospitals get paid.  It does nothing to help "you" to pay the bills (house, car, food, etc.).  A poorly designed health plan is little more than a band aid if a major health event occurs. 

There are a unlimited ways to structure health plans to put the policy holder in the best position possible.  The first thing to consider is "what events could occur that would put you in a precarious financial position"?  The answers are endless, but the obvious things are cancer, heart attack, stroke, illness, or an accident.  Any of these things would be life changing, but there are ways to prepare for the possible financial burden that would definitely follow such events.  The best way that I have found to cover these possibilities is with supplemental products.  There are products available on the market today that will pay cash in the event of heart attack, cancer, stroke, coma, hospitialization, er visits, any form of an accident, and a myriad of other coverages that are essential to a true health coverage plan. 

When I speak about limiting exposure, the idea is that I am limiting the amount of money that you would be "on the hook" for if a medical emergency were to occur.  My goal is to offer the most comprehensive coverage for "the big stuff".  If I can design a plan that will put cash in your pocket for all of the things that would cause you to hit your deductable, then I have done my job.  If you are reaching your deductable, generally something bad happened.  There are the cases of people that have some drawn out illness, or injury that require multiple doctor visits, and other care.  These instances are difficult prepare for, and almost impossible to totally insure. 

The truth of the matter is that there is no perfect insurance package.   We can get close with a combination of traditional health insurance, cash benefit supplements, and discounts through certain associations.  The amount of variables involved in how we manage our health care are ever changing.  Our best bet is to put ourselves in that best position possible, and control what we can.  We limit our exposure by educating ourselves on the process, understanding how products work for us, and by building the most comprehensive plan commensurate to our needs and budget.

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Obama Care part 2...The insurance side

In my last post, I discussed the affects that the Affordable Care Act will have on "us".  Now I would like to detail how it will affect the insurance industry, and how we view our insurance policies. 

First, lets examine how the insurance companies evaluate their business.  Make no mistake, they are a business, and they are in business to make money.  The way that they make money is to receive premiums from consumers.  The way that profit is made is when the amount of the premiums is more than the amount of claims paid out and administrative costs.  When the amount of claims is more than the amount of premiums received, a decision must be made.  Raise premiums, close up shop, or restrict participants by their health status.  Up until now, in order to keep premiums down, insurance companies have made underwriting guidelines more strict.  Enter Obamacare. 

With the new law in place, there are no restrictions on participants due to health status.  This leaves that insurance companies only one option.... raise premiums.  So for all of you that think/thought the Affordable Care Act would make health insurance more affordable, think again.  Consumers will still have the option of getting into an underwritten plan (highly recommended) if they can qualify. 

There are a few ways that the insurance companies will try to keep health insurance manageable for "us".  The first way is to offer higher deductables.  By the end of the year, deductable options will grow to at least $20,000.  They will also attempt to negotiate better rates with the doctors and hospitals.   Another way to keep premiums down is to offer defined benefit plans.  These plans will limit the amount that the insurance companies have to pay toward claims for the policy holder.  There is nothing wrong with these plans, they just increase exposure for the consumer (in trade for a lower premium).  It is possible that some things will not be covered, but time will tell how that shakes out.  Finally, smokers will pay a premium (50% or more than their non smoking counterparts). 

The big question is, who can afford these "huge" deductables?  The answer is supplemental insurance.  There are a handful of companies that offer cash benefit insurances that pay "you" when something unforeseen occurs.  Basically, you can receive lump sum cash if you get cancer, stroke, heart attack, coma, have an accident, or get hospitalized.  These policies will help people navigate through the high deductable waters, and protect themselves in case something bad does happen.

This new law is rife with confusion.  It will cause even more stress for the average consumer when it comes to their health care concerns.  There will be many choices regarding health insurance, and it would be wise to utilize a licensed professional when attempting to find the best solution for you and your family.

 

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Obama Care...Affordable Care Act

This is just another of many posts about this subject.  I will try to shed a little light on how this "Affordable Care Act" will affect the common American. 

I like this map because it illustrates the complexities of the upcoming healthcare law.  There have been many books, blogs, and videos about what this law will do, and how it will affect us.  This image might help all of us to understand that in spite of our best efforts, understanding this Act could be tricky. 

 

Let me start off with what I do know.  Starting in October 2013, everyone will have the ability to obtain a major medical plan regardless of preexisting conditions.  The fact is that most states already have systems in place that offer these plans at very reasonable rates.  As with any large program, there are holes, and some people find themselves in them.  For the people that cannot afford health insurance currently, their situation may not change much.  Unless they are so poor that they actually get coverage for free.  There will be exchanges set up by the Federal gov't or the states (at the present time, over half of the states in the Union have declined to run these exchanges).  Consumers will have a choice of three or four major medical plans.  The law states that all people must be covered by a compliant plan, or they will be taxed.  The tax/penalty will be levied by the IRS at tax time (when we file our taxes).  In 2014, the tax will be $95/ individual, or 1% of their income...Whichever is greater.  For example, if you are making $50,000/yr, you would be assessed a $500 tax when you filed your taxes.  The years following are similar, the tax just increases.  2015  $325 tax, or 2% of income.  2016  $695, or 2.5% of income.  You can see how the taxes can add up.  The other side of the coin is that you could be saving more than the tax if your health insurance premiums are sufficiently lower than the ones offered by the qualified plans.  As always, the "benevolent" government has a solution.  It will offer a subsidy based on income level to help people with compliant health plans to afford them.  The catch is that the subsidy will be in the form of a tax credit.  I'm not sure how the timing of these distributions will work. If this doesn't sound wonderful, it is because it isn't.  By forcing healthy people and unhealthy people to participate in the same health plans;  the prices of the plans will increase dramatically (enter subsidy).  The best example of this is in the current "group" market.  If you work for an employer that offers group health insurance, the premiums are based on the average age and average health of the group.  As long as the group stay relatively healthy, the premiums reflect this and stay low.  When just one of the employees makes a large claim on the policy, the premiums are affected in a negative way.  With the new "gov't" plans, we are telling the health insurance companies that they have to create products to cover an unhealthy pool of people.  All this does is guarantees high rates. 

 

The $64,000 question is, "Who Wins"?  The argument could be made that people with preexisting conditions win.  The Federal Gov't wins by creating a new group of people that "need" its help.  This relationship equals votes. 

 

I chose this picture because I believe that the President looks a little worried, and he should be.  This new health care law is designed to fail.  It was put in place by the powers that be in order to drive healthcare costs up, and force to people to clamor for government intervention....the public option. 

 

The better question is "Who Loses"?  The answer is all of us.  For every person that gets the care that they so desparately need, there will be two that do not.  As costs continue to rise, it will force doctors out of the profession due to decreasing reimbursement rates and rising malpractice insurance.  Less doctors = longer wait times and less qualified people to complete the procedures once you do get in.  When the gov't makes the rule for the insurance companies, they also decide what types of care are covered, and who gets said care.  Every major piece of legislation that comes out of Washington has unintended consequences, and this one will prove to be no different.  

 

So who is the big winner?  NOT YOU!

 

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Why have insurance anyway???

I meet with people everyday...Some are have health insurance but not life insurance.  Some have both, but no long term care insurance.  Others don't have either, and want it.  There is no shortage of situations and reasons why people don't have insurance. 

This is my why guy.

The truth is that there is no real need for insurance...until something happens.  And when that something happens, you can't tick back the clock and hurry up and buy it.  Insurance can be expensive, and some people honestly cannot afford a major medical plan.  Here is a common scenario:  a person that is uninsured goes to the hospital, gets care, and then gets a bill.  I am not here to argue that the price of medical care is reasonable, but for now, it is what it is.  Said person then takes that bill and has a few options:  pay it (which is unlikely if they were uninsured in the first place), don't pay it (let it go to collections), set up a payment plan with the hospital.  If option two is selected, then "who pays"?  This discussion could easily get off track, and go in to the arena of should we provide care to???  That is another blog for another day. 

Now for the answer to the original question.  Why have insurance anyway? 
The answer to this question unfortunately is not found in one black and white place.  Each of us will have a different reason for obtaining a method of medical coverage.  There is one thing that is for sure, everyone should.  If you are not able to self insure (pay for your own medical expenses), then get something that will. 

The American system is built on the concept of personal responsibility.  As more and more of us stray from these ideals, big brother is "happy to help".  When people get care that they cannot pay for; somebody still pays for it.  The bill gets projected on all of us in the form of higher medical costs and higher insurance premiums.  If we want to keep medical costs down, we need to reduce the amount of people getting free/uncovered treatment.  And no, I don't believe that the goverment running the health care industry is the answer. 

My final thoughts on this are as follows.   If you are one of the people that takes personal responsibility for yourself and your family, having insurance will act as a hedge against financial ruin.  If you aren't one of the kind of people mentioned above, look around, your neighbors and friends are going to pay your medical bills if something bad ever happens.

No one has a crystal ball.  There are unlimited options (that fit all budgets) for everyone to have some type of medical coverage.  Having insurance is the only way to prepare for the unforseen.

Opinions, thoughts and comments are always appreciated.

 

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Todd Uzzell
www.insphereis.com/tuzzell
todd.uzzell@gmail.com 

Inaugural Post

I am a Licensed Health and Life Insurance Agent.  This is my first post.  I named my blog for all of the things that people need insurance for.  The truth is that no one needs insurance until something happens, by then, it is too late.  Insurance is more than just something to have in case something happens.  It is a legitimate opportunity to protect yourself and your family from the effects of calamity.  It is the only real way to prepare for the unforseen.  In future posts, I will discuss different stratagies that I use to help people cover themselves.  I will also refer to interesting issues that I run into throughout my daily dealings.  Lastly, I will bring any and all relevant information to this blog to attempt to make it as interesting as possible.