We Will......survive!

[HealthBroker]

Historically whenever the Federal Government steps into the private sector, supposedly to IMPROVE or FIX whatever seems to need fixing . . .here's what happens. Out comes the tools and a lot of dust is created, and the Media gets something to write about, there is a lot of political jousting . . .and sometimes a lot of good gets done . . .and sometimes not. However, at the end of the day when the federal Fixers have fixed the problem, put their tools up and go home. The dust settles. Oh yes, the "FIXERS" have fixed a lot of the known problems but because of "BIG GOVERNMENT INEFFIENCEY" they have inadvertently created a lot more problems . . .which now need to be fixed. These are called "NEW OPPORTUNITIES".
It is my opinion that when the DUST SETTLES . . .no matter what happens in NOVEMBER 2012 or if PPACA is indeed fully implemented in 2014 the opportunities will at least be as good as they are now or better . . .for those who have the patience to recognize them. It is our job as agents in the private sector to come back and point out (to clients and prospects) all of the problems in the new system . . .no matter what the new system is . . .and supply the solution. This is how we get paid. Going forward those of us that have the fortitude to do this will get paid well!! Whereever there is a demand we must supply . . .and a DEMAND there will always be!

 

[Norwayguy]

Louis you are correct about Medicare. ERISA had a similar impact on retirement plans, all but eliminating the defined benefit plan except for public sector and union employees.

Obamacare will eventually, if fully implemented, destroy most of the private health insurance market for individuals, but it will create opportunities for supplemental plans and coverage not even considered at this stage.

I can see critical illness taking off finally in the US just like it does in other countries with government run healthcare.

 

[somarco]

I can see critical illness taking off finally in the US just like it does in other countries with government run healthcare.

Probably a lot of truth there, if the govt takes over everything like they want to.

However I still have serious doubts about the ability to fund this catastrophe.

 

[bill3173]

The exchange has four CLASSIFICATIONS of plans, and there will be a variety of plan designs within those classifications.

Each class of plan has an actuarial value (Platinum 90%, Gold 80%, Silver 70%, Bronze 60%). Included in each package is a minimum set of benefits that each plan must have. From that point, innovation takes over, and there will be as many products as insurers can come up with to satisfy the market.

For instance one Silver plan may have a $250 deductible and pay 50% co-insurance, with expanded coverage for mental health.

Another Silver plan may have a $3000 deductible and pay 100% co-insurance with large copays and expanded prescription coverage.

Another Silver plan may have a $1000 deductible, 80% co-insurance, and it has your prescription in its formulary whereas the other plans do not.

Yet they are all Silver plans at 70% actuarial value.

Disclaimer - these were just examples. No, I didn't crunch numbers to see if these examples really were 70% actuarial value. It's just meant to show that 70% actuarial value can come from a variety of plan designs.

Where did you get this information? Numerous plan designs would be a departure from current gov health plans, either State or Federal.

Not saying you're wrong, but if they allow for that sort of variety, it would sort of defeat the purpose of "simplifying" health plans, which is what they've postulated all along.

 

[Yagents]

They didn't have the guts or the backing for a single payor system, so the opted for government controlled private company distribution.

They couldn't take away "choice" from consumers, so they narrowed it down to 4 plans from each carrier, but will allow them to construct them based on 10 EHB's with 4-5 AV levels. It will not be standardized like med supps

We'll see how the "you won't lose your doctor or plan" turns out.....

 

[taterpeeler]

Look... the more confusing the plans and system the better...... last thing you will see is 300 million americans sorting through this maze. Navigators will be like" dang if I know, call a broker"

 

[bill3173]

They didn't have the guts or the backing for a single payor system, so the opted for government controlled private company distribution.

They couldn't take away "choice" from consumers, so they narrowed it down to 4 plans from each carrier, but will allow them to construct them based on 10 EHB's with 4-5 AV levels. It will not be standardized like med supps

We'll see how the "you won't lose your doctor or plan" turns out.....

Well, I haven't delved into it that much, but I do the State and Fed Plans weekly, and the plans are basically brown, black, vanilla, with one coverage twist on one of the plans.

If all of this variety is true, then health agents will still have a job. However, it is ridiculous that the wheel was re-invented just to expand government.

The Single payor people have something in common with the status quo crowd. Neither got anything close to what they wanted.

 

[Yagents]

If we are confused, just think about average Joe. I see it like this:

Me: What is you bottom line 1040 AGI?
Prospect: "X"
Me: Medications, health conditions, current coverage?
Prospect: "X"

Me: Let me do my analysis...........you will get X subsidies, and based on your medical conditions, I recommend you go with X company, and this metal plan. You will pay less premium, and less out of pocket for your known conditions/meds. This scenario replaces the underwriting process agents currently do.

Think of it as a manual medicare plan D analysis. The person that can make it automated, can make a lot of money. Essentially matching up the thousand medical conditions to the AV payout of each plan on the exchange.

 

[taterpeeler]

If we are confused, just think about average Joe. I see it like this:

Me: What is you bottom line 1040 AGI?
Prospect: "X"
Me: Medications, health conditions, current coverage?
Prospect: "X"

Me: Let me do my analysis...........you will get X subsidies, and based on your medical conditions, I recommend you go with X company, and this metal plan. You will pay less premium, and less out of pocket for your known conditions/meds. This scenario replaces the underwriting process agents currently do.

Think of it as a manual medicare plan D analysis. The person that can make it automated, can make a lot of money. Essentially matching up the thousand medical conditions to the AV payout of each plan on the exchange.

which in english means.... agent involment.... real agents, not what bamm thank you mamm

the turn and burn guys will be gone, just as I expected

 

[Ann H]

Where did you get this information? Numerous plan designs would be a departure from current gov health plans, either State or Federal.

Not saying you're wrong, but if they allow for that sort of variety, it would sort of defeat the purpose of "simplifying" health plans, which is what they've postulated all along.

Seems that nobody can explain this "actuarial value" very well.

Kaiser tried, by hiring 3 actuarial firms... If you can understand their methodology and conclusions please educate me! The link is - http://www.kff.org/healthreform/upload/8177.pdf

The IRS is touting the new AV (Actuarial Value) Calculator that HHS is supposedly coming out with where employers can input the basic benefits structure (deductible, co-insurance percentage, out-of-pocket, copays, etc.) and the calculator will tell them the actuarial value of the plan. The link is - Internal Revenue Bulletin - May 14, 2012 - Notice 2012-31

Regarding that magic AV calculator and all it's supposed to do, here's a bulletin from HHS. http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf. Pretty interesting reading. In response to your direct question, let me quote a few paragraphs that explain how the actuarial value of the 4 metal tiers is meant to help consumers understand the relative value of insurance plans, despite the various benefit structures and design elements in the plans.

AV is expected to be used by consumers to compare QHPs and non-grandfathered individual and small group market plans with different cost-sharing designs and as a method for consumers to understand relative plan value. Quote comes from Page 2

This bulletin describes the intended proposed methodology for calculating AV for qualified health plans (QHPs) and non-grandfathered health plans in the individual and small group markets. We intend to propose a methodology for the calculation of AV for these plans that provide consumers the most direct comparison of plan benefit generosity across multiple issuers. We note that in other markets in which plans are not required to offer EHBs, there is greater variation in plan design covered across issuers. One way to ensure that QHPs and non-grandfathered individual and small group market plans meet the AVs in the metal tiers is to standardize the cost-sharing for each plan. For example, all silver plans could be required to have the same cost-sharing structure. As a potential alternative, plans could have the flexibility to independently develop cost-sharing structures as long as each plan’s AV is equal to 60 percent, 70 percent, 80 percent or 90 percent. AV would be defined using formal rules that ensure actuarial equivalence within a metal tier. We intend to propose the latter approach; QHPs and other non-grandfathered individual and small group market plans must meet the AVs in the metal tiers. Quote comes from Page 3-4

Develop a publicly available AV calculator that plans would use to determine AV. The calculator would be developed using a set of claims data weighted to reflect the expected standard population in the individual and small group markets for the year of enrollment. Plans would input information on cost-sharing parameters. Both the logic and the tables of aggregated data used to develop the calculator would be made public to maximize transparency. The calculator method ensures a consistent set of assumptions and methods in AV calculation, maximizing comparability for consumers since plans with the same cost-sharing design would have the same AV. We intend to propose the third approach to be used to determine the AV of QHPs and non-grandfathered individual and small group market plans. Our intention is that the proposed AV calculator would be a publicly available, dynamic tool. Health plans could input their plan design and the calculator would provide the AV of the plan. The calculator would be universally available for both formal and informal calculations and could be used as a tool to assist issuers in the design of health plans. This would allow health plan issuers to devise an optimal plan without the burden of making the assumptions needed for an AV calculation themselves. Thus, the AV calculator would reduce issuer burden in calculating AV. We intend to propose that issuers would be able to input into the AV calculator a limited set of information on the benefits offered in a plan and this information would be sufficient to produce the AV of the plan. We expect a handful of cost-sharing features to have a large impact on AV including: deductible, co-insurance, maximum out-of-pocket costs, and to a lesser extent: cost-sharing for emergency room visits, inpatient admissions, and diagnostic imaging. However, because the vast majority of medical costs are dedicated to physician and mid-level practitioner care; hospital and emergency room services; pharmacy benefits; and laboratory and imaging services, not all cost-sharing information will have a material impact on AV. Further, because only a small percentage of total inpatient costs come from out-of-network utilization, we intend to propose that the calculator only consider the value of in-network service use. HHS recognizes that including a larger number of inputs could theoretically improve the accuracy of the AV calculator. We also recognize the need to accommodate innovative plan design features that are meaningful to consumers, such as Value-Based Insurance Designs that vary the copayment or coinsurance for items and services based on expected value. At the same time, there is a limit on the number of features that can be recognized for incorporation in a practical and easy-to-use AV calculator.
Given the intended uses of the AV calculator, we seek comment on which inputs, benefits, and services are most appropriate to include... Although we anticipate that the vast majority of QHP issuers would be able to calculate the AV of any given plan using the proposed calculator, it is possible that the calculator would be unable to accommodate some plan designs directly. For example, if a QHP issuer designed a plan with a $1,000 deductible, 20 percent copayment up to $2,000 out-of-pocket, and then 40 percent copayment up to a $6,000 out-of-pocket maximum, we expect the calculator would not be able to directly accommodate those parameters, because of the two coinsurance rates. Similarly, if an insurer offers a multi-tier network with substantial amounts of utilization expected in tiers other than the lowest priced tier, adjustments to the calculator output may be needed. In order to facilitate innovation in plan design, we are considering two options: 1. Allow QHP issuers the leeway to fit plan designs into the calculator logic and then have an actuary certify that the plan design was fit appropriately. 2. Allow issuers to use the AV calculator for all the major plan provisions. For those plan design provisions that deviate substantially from commonly used cost-sharing features, allow issuer actuaries to calculate appropriate adjustments in accordance with actuarial standards of practice. Quote comes from Page 6-8
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Now, isn't that clear as mud? Every insurance agent on this board just thought of a dozen plan designs that would appear to have an actuarial value of one of the tiers, but doesn't actually have that value to a given client. The insurance companies will make it even clearer than mud by creating various designs that just barely make it inside the "tier" of platinum, gold, silver, or bronze, but set it apart for marketing purposes. Lots of room for agent communication to clients. It's too bad we spent billions to accommodate PPACA's simplicity. For years, agents have been generally classifying plans into 4 distinct classes - Cadillac, Expensive, Most Popular, and Pure Trash.