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2 months ago · by · 0 comments

Big Changes to Health Insurance!

Some big changes to your health insurance are afoot. You’ve most likely heard about the massive $1.9 trillion COVID-19 relief bill that was enacted by Congress and signed into law by President Biden last week. But what you may not have heard is that the bill addresses one of the most significant longstanding issues with the Affordable Care Act. The problem is known within the industry as the “subsidy cliff,” and it means that benefits of the Affordable Care Act decline or stop abruptly once a certain income threshold is met. Under the old rule, if Linda makes $45,000 per year she would pay $318 per month for a silver plan, or 8% of her income. But if she gets a raise to $50,000 per year, the change pushes her over the subsidy cliff and the subsidy stops, causing her premiums to skyrocket to $943 per month, or 23% of her income. How does that happen?

The answer lies in the way the ACA was originally written in 2010. It was a bit of a Frankenstein’s monster with all the compromises required to appease the competing interests and get it moved through Congress. The primary consideration at that time was to reform the industry and require insurers to cover patients with pre-existing conditions and make sure that basic coverage was adequate for everyone. Pretty much everybody knew that those things would cause premiums to rise because insurance companies can’t assume increased risk and cost without increasing revenue, and so a way to offset those additional costs was needed. The compromise reached was the individual mandate, which required everyone – including young and healthy people who didn’t qualify for subsidies – to purchase health insurance to balance the risk pool.

This worked somewhat, but not particularly well, and a lot of middle-income earners saw their premiums increase substantially. Then in 2017 as part of the massive tax overhaul, Congress made it even worse by removing the individual mandate, stripping away the few protections it did provide and pushing premium costs even higher. The result was a dysfunctional schism where low-income earners who qualified for subsidies were paying little or nothing, and marginally higher earners who didn’t qualify for subsidies were paying astronomically high premiums.

Under the old rule, subsidized earners were expected to pay anywhere between 2% and 9.8% of their earnings on a sliding scale, and non-subsidized earners paid pretty much market premiums. Under the 2021 reform, no one who buys insurance on the exchange is required to pay more than 8.5% of his or her income in premiums. This will be particularly helpful to people living in states that have not elected to expand Medicaid under the ACA. As a bonus, the Congressional Budget Office estimates that the change will be dirt cheap relative to the overall cost of the massive spending bill, just $22 billion out of the $1.9 trillion.

Unfortunately, the change is temporary and will expire in 2023, but Congress has until then to make it permanent. The current Special Enrollment Period ends May 15, so be sure to contact us today to see how this change will affect you before it’s too late.

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7 months ago · by · 0 comments

Congress Limits Medicare Part B Premium Increase

Good news! We could all use some these days, right? Well if you are a Medicare beneficiary enrolled in Part B, here you go. Your Part B premium increase next year will be about $4.

Last week, House Speaker Nancy Pelosi’s office announced that Congress had reached a budget agreement which would add enough funds to Medicare to keep Part B premium increases largely in check for the next year. This is especially welcome news, considering that the Centers for Medicare and Medicaid Services had previously calculated that 2021 premiums could increase by as much as $50 per month from the current 2020 base premium of $144.60. Such a single-year increase would have been larger than all the increases of the previous decade combined, and could leave many with limited means unable to pay. This alarming projection was largely in response to increased emergency Medicare spending to battle the COVID-19 pandemic.

The Speaker’s office said that premium increases were expected to average around $4 per month instead of the previously projected $50, which is especially important to the roughly 2/3 of Medicare beneficiaries who have the premium deducted from their monthly Social Security income. The Social Security Administration last week announced a 1.3% cost of living adjustment for 2021, which will average around $20 per month for most recipients, meaning that recipients may actually get to see a little bit of that increase in their pockets. It also means that the “hold harmless” provision won’t kick in, meaning that extra costs above the COLA won’t be redistributed to beneficiaries who are not yet drawing Social Security, and that’s good for everybody.

The annual Medicare Part B premium increase has been one of the fastest-growing costs of retirement in recent years, increasing 218% in the last 20 years, compared to a corresponding 54% inflation rate. It increased 7% last year alone. So this relief will certainly come as welcome news to seniors at a time they need it most. Congress finally did something right.

As always, contact us with your concerns about anything to do with your Medicare.

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7 months ago · by · 0 comments

Self-Checkout Insurance?

Walmart made a lot of waves in the insurance world last week by announcing that its in-house brokerage unit, known as Walmart Insurance Services, would begin selling Medicare Advantage and Part D plans for the 2020 Annual Enrollment Period this fall. This understandably created concern among independent insurance agents that we would now be directly competing with Walmart for our clients, a position that clearly not many people whose name doesn’t begin with “Amazon” are anxious to be in. Indeed, there are very few who can compete effectively with Walmart for most products.

But there are a couple of factors that make Walmart insurance very different from other types of products they sell. Generally, Walmart only has one bullet in its marketing gun – low prices. If Walmart were to become an insurance carrier like Aetna, Humana, or Cigna, and begin underwriting their own Walmart branded policies and paying claims, it’s possible they might be able to offer lower prices on their policies because they would control the underwriting and premiums. But that isn’t what they are doing. Walmart is a broker (i.e., agent), and they are selling the exact same Humana, United, and Wellcare policies that every broker in the country has access to. That means you pay the exact same amount for your policy whether you buy it through Walmart or an independent agent, and thereby Walmart loses their one weapon – the ability to control price.

The other thing that makes insurance different is the basic economic difference between products and services. Walmart products are commodities – things that you can buy virtually anywhere. It doesn’t matter whether you buy your peanut butter at Walmart, Kroger, Dollar General, or Sprint Mart. It’s still the exact same peanut butter, and the only difference is how much you pay at the different outlets. Commodities is where Walmart steamrolls everyone. But insurance is not a product; it’s a personalized service. A good agent has to take the time to develop a relationship with you in order to thoroughly understand your needs and recommend the product that is right for you, even if it means a lower commission for the agent. Most insurance products also have varying underwriting requirements, and the simple fact is that a lot of applications that get submitted through Walmart will be denied because the agent either didn’t understand the client’s needs or have the experience to know which companies have the most favorable underwriting. You can’t just choose a policy based on a price tag, and insurance is a relationship business that can’t be run through the express checkout lane.

Products are easy, and Walmart is good at them. Services are hard and require time, experience, and relationships in order to be provided the way they are supposed to be, and Walmart is not good at that. When was the last time you got quality, personalized service at Walmart? Right, that’s what I thought. So while there will unquestionably be some people who find Walmart insurance compelling, they are almost certainly the same people who would never have gone to a quality independent broker anyway. Our business will always be built on personal relationships, trust, and expertise.

So, self-checkout insurance? I don’t think so.

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7 months ago · by · 0 comments

Scammers Are At It Again!

Social Security scammers are at it again. Remember – never give out any personal or banking information over the phone, no matter how much the caller insists or threatens.

In recent days, a number of our clients have received a scam telephone call related to their Social Security. While these phony calls are not new and have been a persistent threat for years, there does seem to be a new wave currently underway in our area. The call may come in several different variations, but typically will begin with a recorded message informing the recipient that his or her Social Security number has been compromised and is being used for identity theft or other criminal purposes, and then ask the recipient to hold for an operator.

The operator will typically claim to be from the Social Security Administration or other government agency and begin asking for detailed personal information including Social Security numbers, bank account numbers, or other financial information in order to safeguard the recipient’s Social Security benefits. In some cases, the caller may claim to be from a law enforcement agency and threaten the recipient with fines, imprisonment, or other penalties for failing to pay a fee immediately. DO NOT GIVE OUT ANY PERSONAL INFORMATION OVER THE PHONE, no matter how much the caller insists.

As a reminder, the Social Security Administration will never:

  • Call to threaten you with arrest or legal action;
  • Tell you that your Social Security number has been suspended or revoked;
  • Offer to resolve identity theft issues in return for a payment;
  • Offer to increase your benefits in return for payment of a fee;
  • Demand secrecy in handling a matter related to your Social Security;
  • Send you a text message about a problem with your Social Security number or benefits;
  • e-mail you documents containing personally identifiable information;

Generally, the Social Security Administration will communicate with you via postal mail, and if you ever need to submit payments for any reason, the SSA will send you an official letter with details and instructions. Never make payments via pre-paid debit or gift cards, Internet payment services, wire transfers, or cash. Scammers ask for these types of payments because they are difficult for law enforcement to trace.

If you receive a suspicious call, your best course of action is to hang up and report it to the Office of the Inspector General using a dedicated online form located here. If you are unable to access the form for any reason, call your local Social Security Administration office for instructions on how to report the incident.

As always, you may contact us with questions related to health or disability benefits and we will point you in the right direction.

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7 months ago · by · 0 comments

What Is Medicare Advantage and Do I Need It?

The Medicare Annual Election Period (AEP) runs from October 15 to December 7, and so beginning around October 1 every year, you probably see advertisements for Medicare Advantage plans just about every time you turn on your television. These ads are usually touting all the benefits of Advantage plans and telling you how you should be enrolled in one if you are over 65 and give you an 800 number to call. The fact is that Medicare Advantage may indeed be right for you, depending on where you live and your particular situation, but it’s important to understand clearly what Medicare Advantage is – and isn’t – before you put too much stock into those ads. It’s vital that you consult with an experienced Medicare professional to review your needs and options before making that move.

Medicare Advantage, often referred to as Medicare Part C, is a completely different way to receive your Medicare benefits from original Medicare. Under original Medicare, you have separate Part A (hospitalization) and Part B (medical expense) coverages that are administered by the government through the Centers for Medicare and Medicaid Services, and a separate Part D (drug plan) that is administered through a private insurance company that has contracted with CMS. Under this model, you may be enrolled in various combinations of A, B, and D plans with separate coverages for each.

Medicare Advantage is a way of conveniently rolling all of your A, B, and D benefits into a single health plan administered through a private insurance company. These companies contract with CMS in much the same way they do for Part D drug plan coverage, and they agree to deliver at least the same benefits as original Medicare in return for reimbursements from CMS. In addition to the standard Medicare benefits, these plans frequently include additional benefits not included in original Medicare, such as vision, dental, or hearing coverage. Additionally, all Medicare Advantage plans include the protection of a maximum annual out-of-pocket limit that you don’t have under original Medicare. But if you currently have a Medigap supplement, you’ll have to give it up, because you can’t have both a supplement and an Advantage plan.

Sounds pretty nice, huh? Well, yes, but…. there are some tradeoffs that have to be weighed out before deciding whether it’s right for you. The most important is that under an Advantage plan, you are locked into provider networks that may or may not be beneficial for you. If your doctor or pharmacy is not part of the network set up by your plan provider, it’s possible that you might have to find a new one that is. And if you travel outside of your network area, you may have additional costs if something happens and you need to see an out-of-network provider. Under original Medicare and a Medigap supplement, you are free to see any provider who accepts Medicare without those restrictions.

There are also some costs associated with Advantage plans that you don’t have under original Medicare, starting with a monthly premium in addition to the Part B premium that you already pay. Some plans may offer a premium as low as $0, while others may charge a higher amount, but it is always there. And while Advantage plans do offer the security of annual out-of-pocket limits, there are back-end costs that can add up in some situations, including copayments and coinsurance that don’t exist under original Medicare. A copayment when you visit your doctor might not be significant if you only see your doctor every few months, but if you develop a health issue that requires frequent visits, a copay can quickly add up to more than the cost of a good supplement.

Lastly, Medicare Advantage plan benefits, networks, and premiums can change year over year. If you joined a particular plan for a certain benefit or because your doctor or pharmacist is in-network, you can be left with some difficult choices to make if those factors change at some point. You may choose to find another Advantage plan or go back to original Medicare, but getting a Medigap supplement may be more difficult if your health has changed because you will have to pass health underwriting.

These issues can be very complex, and it’s vital that you not try to make these decisions alone. Talk to an experienced Medicare professional that you trust to find out whether an Advantage plan is right for you. If you have questions, we are here to help and will be happy to sit down and assist you in choosing the right plan at the lowest cost. There is never a charge for a consultation, and we will never recommend a plan that isn’t right for you just to make a sale. Call us at (662) 269-2519 or email us to schedule an appointment with one of our experts to examine your options.

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8 months ago · by · 0 comments

Medicare AEP 2020 – Are You Ready?

It’s getting close to that time again. The Medicare annual enrollment period is almost here, and even though it’s not quite time yet, you should definitely be giving some thought to your needs. There are exciting new options and lots of changes coming for next year, and with so many options available it can seem a little overwhelming at times. But we are here to help, and our hometown Medicare specialists can help you make the right choice to be sure you have the coverage you need at the best price.

Here’s what you need to do now to be ready:

During the month of September, you should be on the lookout for any letters or notices regarding changes to your existing coverage, as many insurers will make changes to premiums and benefits during this time. New healthcare plans and providers may also join or leave your network year over year. Additionally, Congress or other government agencies may periodically make changes to Medicare that might affect your benefits, so it’s important to stay abreast of those.

These notices are time sensitive, because if you need to make changes to certain coverage, that must be done during the Medicare Annual Enrollment Period (AEP) beginning on October 15 and ending on December 7. If you miss this window of opportunity, you will probably have to wait until next year to make changes to your coverage.

It’s also possible that your health needs may have changed during the past year, due to either a new medical condition that requires additional coverage, or possibly you might need to modify your coverage to reflect an improvement in your health. If that’s the case, the coverage that worked for you last year might not be the best choice this year, even if your premiums and benefits don’t change.

The best way to stay on top of these changes and be sure you aren’t inadvertently left with new coverage gaps is to talk to a Medicare professional every year. That’s where we come in. There’s absolutely no cost to call or come in for a free annual review of your health coverage. Our friendly hometown Medicare specialists will be glad to make sure you understand all your options and have the coverage you need and the lowest possible cost. But remember – we will be swamped beginning in October, so don’t wait. Call for your completely FREE coverage review today. 662-269-2519 or email us.

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2 years ago · by · 1 comment

It’s open enrollment time!

Open Enrollment October 15-December 7

Yes, it’s open enrollment time again! Did you know that most Medicare Advantage and prescription drug plans change from year to year? Sometimes those changes can be quite significant. That means the plan that was right for you last year may not be the best plan this year, so it’s important to get a good checkup on your plan every year during open enrollment. Stop by our new office at 1744 Cliff Gookin Blvd for your FREE consultation and let our healthcare experts take the headache out of reviewing your plan options. We’re your friendly one-stop healthcare service agency, and we’re here to save you money! Call us at 662-269-2519 or send us an email today.

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2 years ago · by · 1 comment

Ask the Cash Price on Your Medications

Ask the Cash Price

Did you know that your pharmacist can often lower your out of pocket expense for your medications if you ask? Just ask the cash price.

You read that right. All you have to do is ask, especially if your prescription is for a generic. It’s fairly common knowledge that there are many different prices for medical services and prescriptions, depending on your particular payment method. We all know that healthcare providers frequently charge higher prices to patients with insurance than cash-paying clients. Why this is legal remains a mystery to us, but that’s another topic for another day…

What you may not know is that insurance carriers often have “gag orders” in their contracts with pharmacists that prevent them from disclosing to their customers that a lower price exists on a medication. In many instances, the cash price for your medication may actually be less than your co-payment amount, and your insurance company may be pocketing the difference. Cash prices for generic drugs began dipping below co-pays many years ago when big-box retailers like Walmart, Walgreens, and Rite-Aid started offering $4 prescriptions for dozens of generic drugs. Although these programs are not as common as they were a few years ago, they have successfully driven down cash prices for generics to often “below co-pay” levels. The result is that your pharmacist can’t tell you there is a lower price, but you can ask and they have to tell you.

While no one really denies that these clauses exist, insurance carriers and drug manufacturers naturally deny that they are common, although a 2016 survey of 600 pharmacists found that 84% reported that patients had been overcharged 10 or more times in the previous month, and 35% reported that it had happened 50 or more times. A recent research letter published in the Journal of the American Medical Association reviewed 9.5 million Medicare Part D prescription claims and found that 25% of drugs purchased had a lower cash price than the co-payment that was actually paid by the customer. The overpayments were usually small, although some were as high as $30.

So the next time you visit your pharmacist, be sure and ask the cash price before you file it on your insurance. You might end up saving some money in the process.

Questions or comments? Post a comment below and let us know what you think! Also, don’t forget to contact us and get a FREE review of your drug plan to see if you are saving the most money possible.

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2 years ago · by · 1 comment

Affordable Care Act – So what’s actually going on?

Affordable Care Act

So if you’ve turned on a cable news program in the last year, you’ve probably heard that the Affordable Care Act is tied up in the courts – again. But why is it back in the news this week, what’s really going on with it, and what does it potentially mean for you? Well, the answer to that question is kind of a mess, and the fact is that nobody really knows where we are or what to expect. It’s a long and messy tale, but here is what we know and don’t know.

The legality of the Act has been challenged in court since virtually before the ink was dry by multiple Republican state Attorneys General. In 2012, the US Supreme Court led by Chief Justice John Roberts ruled 5-4 that while the Congress does not have the Constitutional authority to order people to purchase health insurance, it was within Congress’s taxing authority to levy a financial penalty on people who don’t purchase it. Roberts wrote, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax.” So that is the legal leg that the law has stood on since then. It’s a tax law.

Republicans in Congress have tried repeatedly over the years to repeal the act, with the House and the Senate voting no less than 50 times on the issue, and actually sending a bill to President Obama’s desk in 2016, where it predictably died with a veto. Republicans most famously tried to repeal it under the Trump administration in September 2017, where it passed the House and subsequently died in the Senate by one vote, with Senator John McCain giving his famous “thumbs down” to join two other Republican Senators in defeating the measure.

Unable to pass a full repeal, the Republican-led Congress settled for what they could get – in the massive 2017 tax bill, they sneaked in a provision that eliminated the tax penalty on people who don’t purchase insurance. The rest of the ACA, including its protections for people with pre-existing conditions, remained in effect as always. However, that move had unintended consequences.

Sensing an opportunity, several Republican state Attorneys General, led by Texas and supported by the Trump Justice Department, launched a new legal challenge to the law under a relatively novel theory. They argued that without the financial penalty, the requirement to purchase insurance cannot stand, and that that single requirement is so central to the entire law that the whole thing must be struck down. In 2018, a Federal District Court Judge in Texas agreed. Judge Reed O’Connor accepted that argument and ruled the entire ACA unconstitutional.

This predictably sent waves of uncertainly throughout the healthcare world, but legal scholars on both sides questioned O’Connor’s reasoning and did not give the decision much chance of being upheld on appeal to the 5th Circuit Court of Appeals. However, during oral arguments before a three-judge panel at the 5th Circuit last week, two of the three judges hearing the case indicated that they might be inclined to support O’Connor’s reasoning, opening the door to the possibility that the law might actually be invalidated after all.

Regardless of how the 5th Circuit rules, that ruling will almost certainly be immediately appealed to the Supreme Court, where there would be two possible courses of action. First, the Supreme Court doesn’t have to hear any case it doesn’t want to, and they could simply decline to hear the case, allowing the lower court ruling to stand and become the law of the land. Considering the stakes and the intense media scrutiny of the case, it seems pretty unlikely that they would refuse to hear it. In the more likely scenario, the Court would agree to hear the case, and there would be no action on it until the Supreme Court returns to session in October. After filing briefs and hearing oral arguments, the Court would then take several weeks or months to deliberate and make its decision. The Supreme Court historically saves big, high-profile rulings for the last couple of weeks of the term in late June or early July, so we are very unlikely to have a final decision for at least another year or so, maybe longer.

So what does this all mean for you and your health insurance coverage? For the next few months, probably nothing. If the 5th Circuit upholds the District Court’s ruling invalidating the ACA, that decision would likely be stayed (not implemented) pending appeal, meaning that nothing would change until the Supreme Court hears the appeal. This is fairly normal procedure when all parties know that the ruling is going to be appealed and the Court doesn’t want to completely flip over the apple cart and create chaos, only to be reversed on appeal.

However, if the 5th Circuit affirms the lower court’s ruling and the Supreme Court either declines to hear the appeal or upholds the decision, the impact would be widespread and immediate. Any protections for people with pre-existing conditions would be gone, meaning that you could be denied coverage altogether or pay higher premiums for your coverage if you have a pre-existing condition. Additionally, an estimated 20 million Americans who obtained health insurance after the Affordable Care Act was enacted, either through the marketplaces that were established or through the state Medicaid expansion, could lose it.

If that happens, there doesn’t appear to be any contingency plan in place. Democrats are all over the map in terms of healthcare proposals with no consensus on how to proceed, and Senate Majority Leader Mitch McConnell has said that the Republican-led Senate will not take up any healthcare-related issues before the 2020 election. Of course, that can change if the political situation becomes desperate enough for him, but for now we are left with nothing but uncertainty. As much as Republicans have dreamed of repealing the Affordable Care Act, it might be a case of the dog that caught the car, because now that they might have, they don’t know what to do with it.

Watch this issue carefully, and call your Senators and Representatives in Washington and ask them what they plan to do to protect people with pre-existing conditions if the Affordable Care Act is struck down. You deserve an answer. Do you have thoughts on it? Post a comment below and let us know what you think!

Contact us today to discuss your coverage and see if you might be at risk.

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2 years ago · by · 1 comment

Our new Tupelo office is now open!

Well, after several weeks of sweat, hand-wringing, and haggling, our new Tupelo office is finally open. We have everything painted, patched, and (with a couple of exceptions) installed. The signs won’t be installed for another week or so, so we might be just a little hard to find until that gets in. We are at 1744 Cliff Gookin, which is between South Gloster and Lawndale. That’s actually right before you get to Lawndale if you are driving from Gloster. Here’s the Google Map link:

https://goo.gl/maps/9niQ6qaNJYtsGfoo6

As you can see, our brand spanking new web site is also live. It’s still missing a little polish around the edges, but everything should be working and ready to go.

The office is open, the web site is live, and we are ready to roll. So stop by and see us, because we’re handing out quotes like Halloween candy. 😁 Even if you don’t need a quote today, stop by anyway just to say hi and see the office.

See you there!

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Company Information

Burns Insurance Group
Tammy Burns
Alan Burns

1744 Cliff Gookin Blvd
Tupelo, MS 38801

E-Mail

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(662) 523-2788

9:00am - 5:00pm Monday - Friday