1 00:00:01,501 --> 00:00:05,505 And now America's Healthcare Advocate, Cary Hall. 2 00:00:05,672 --> 00:00:06,339 Hello, America. 3 00:00:06,339 --> 00:00:09,576 Welcome to America's Healthcare Advocates, broadcasting coast to coast 4 00:00:09,843 --> 00:00:13,013 across the USA here on the HIA Radio Network. 5 00:00:13,146 --> 00:00:14,447 You can find out more about us 6 00:00:14,447 --> 00:00:18,218 by going to our website, AmericasHealthcareAdvocate.com. 7 00:00:18,451 --> 00:00:21,554 All these shows are posted on your favorite podcast platforms 8 00:00:21,554 --> 00:00:24,858 Spotify, SoundCloud, Rumble, you name it, we're on there. 9 00:00:24,858 --> 00:00:27,861 And the YouTube platform America's Healthcare Advocate. 10 00:00:27,927 --> 00:00:29,429 My producers in studio. Mr. 11 00:00:29,429 --> 00:00:31,531 Dave Thiessen behind all the cameras today. 12 00:00:31,531 --> 00:00:33,066 The man who puts all this together 13 00:00:33,066 --> 00:00:35,668 gets it up on all the podcast and YouTube platforms. 14 00:00:35,668 --> 00:00:38,571 And Garner Cowdrey here from Cumulus, a recording today's 15 00:00:38,571 --> 00:00:41,574 show and doing all the audio work so we can bring this out 16 00:00:41,608 --> 00:00:44,010 to all of our affiliates across the country. 17 00:00:44,010 --> 00:00:46,880 So in studio with me today, Carolee Steele and Maria Ahlers, 18 00:00:47,947 --> 00:00:49,716 from RPS Benefits by Design. 19 00:00:49,716 --> 00:00:50,683 Welcome back for the. 20 00:00:50,683 --> 00:00:52,619 I don't know what this the 50th show. 21 00:00:52,619 --> 00:00:55,255 We feel like an old married couple. 22 00:00:55,255 --> 00:00:58,258 We've been doing this for a while. 23 00:00:59,592 --> 00:01:00,760 So what are we doing today? 24 00:01:00,760 --> 00:01:03,563 Well, there's a lot of chatter out there. Okay. 25 00:01:03,563 --> 00:01:07,467 That's about the best way I can put it about what's going to happen with ACA. 26 00:01:08,101 --> 00:01:10,570 And, you know, I'm seeing pieces 27 00:01:10,570 --> 00:01:14,040 in the media that are portraying, you know, what's going to occur 28 00:01:14,040 --> 00:01:17,710 and the changes that are going to happen and how they're going to impact people. 29 00:01:17,911 --> 00:01:20,613 And unfortunately, there's a lot of false narrative out there. 30 00:01:20,613 --> 00:01:24,184 So I'm going to I'm going to step in here for a minute and kind of explain 31 00:01:24,451 --> 00:01:27,353 where we're at on the individual health insurance market 32 00:01:27,353 --> 00:01:30,356 on Obamacare and ACA, how we got here. 33 00:01:30,590 --> 00:01:32,725 Okay. And then what does that look like? 34 00:01:32,725 --> 00:01:35,228 So let's just start off with some facts, okay? 35 00:01:35,228 --> 00:01:39,399 Between 2014 and 2019, benchmark premiums 36 00:01:39,399 --> 00:01:43,770 for ACA plans increased as much as 90%, 90%. 37 00:01:43,770 --> 00:01:46,706 Okay. And we'll talk about why here in a little while. 38 00:01:46,706 --> 00:01:49,476 Rural counties have been hit especially hard. 39 00:01:49,476 --> 00:01:52,745 52% of the counties participating in Obamacare 40 00:01:52,846 --> 00:01:58,551 only had one plan, because the carriers either don't have the ability 41 00:01:58,551 --> 00:02:02,689 to do a network or they can't get access to care in those rural markets. 42 00:02:02,689 --> 00:02:04,324 So there's another problem. All right. 43 00:02:04,324 --> 00:02:07,227 So federal subsidies and this is where 44 00:02:08,228 --> 00:02:09,796 it starts to become an issue. 45 00:02:09,796 --> 00:02:13,666 Federal subsidies are now at a $100 billion a year, 46 00:02:13,900 --> 00:02:19,339 100 billion, which in ten years is $1.2 trillion. 47 00:02:19,606 --> 00:02:23,943 So what we've got here, all right, is we've got an unsustainable situation 48 00:02:23,943 --> 00:02:25,111 that cannot continue. 49 00:02:25,111 --> 00:02:28,548 And what prompted all this, what caused us to move 50 00:02:28,915 --> 00:02:31,718 from where this thing was originally designed, 51 00:02:31,718 --> 00:02:35,788 was the changes made in 2021 and on out, 52 00:02:35,955 --> 00:02:39,259 where we moved the poverty level up to 400% of the 53 00:02:40,493 --> 00:02:44,030 of the annual poverty level, which means we increased, 54 00:02:44,430 --> 00:02:47,333 increased the subsidies significantly. 55 00:02:47,333 --> 00:02:52,172 And that's where we had a huge number of people enrolled in these plans, 56 00:02:52,472 --> 00:02:56,342 because at that point, the subsidies' were up to as we as 57 00:02:56,342 --> 00:03:00,580 I just talked about, okay, billions of dollars that weren't planned for 58 00:03:00,914 --> 00:03:02,982 this was as a result of Covid. 59 00:03:02,982 --> 00:03:04,751 It was supposed to be temporary. 60 00:03:04,751 --> 00:03:08,288 But you know as well as I do, anytime you introduce a government program 61 00:03:08,488 --> 00:03:11,491 where you're handing people money, it's not going to be temporary. 62 00:03:11,624 --> 00:03:14,861 Well, actually, it is this time because it's being pulled back. 63 00:03:15,195 --> 00:03:15,695 Okay. 64 00:03:15,695 --> 00:03:18,031 And what's happening is the Trump administration 65 00:03:18,031 --> 00:03:21,434 is bringing it back to what it was originally designed to do. 66 00:03:21,868 --> 00:03:23,703 Now, that's not what you're seeing in the press. 67 00:03:23,703 --> 00:03:25,138 That's not what you're hearing. 68 00:03:25,138 --> 00:03:27,840 You're hearing that the Trump administration is going to throw 69 00:03:27,840 --> 00:03:31,911 8 million people off of the Medicaid and ACA plans. 70 00:03:31,911 --> 00:03:34,647 Okay, I broke that down on another show. 71 00:03:34,647 --> 00:03:37,650 I'll very quickly just make sense out of this. 72 00:03:37,984 --> 00:03:41,087 Over 1.4 million of those people are illegal aliens, 73 00:03:41,421 --> 00:03:44,424 okay, that are on the plans like in California other places. 74 00:03:44,557 --> 00:03:47,160 And the remainder of those people that are going to be displaced on 75 00:03:47,160 --> 00:03:51,030 these plans are people that are going to lose those subsidies up to 400%. 76 00:03:51,331 --> 00:03:54,601 The plan was when President Obama, qnd this passed. 77 00:03:54,901 --> 00:03:55,235 Okay. 78 00:03:55,235 --> 00:03:58,605 And John McCain was the passing vote in the Senate, pushed it through. 79 00:03:58,938 --> 00:04:04,344 The idea was to give people subsidies up to 150 to 200% of the poverty level, 80 00:04:04,444 --> 00:04:07,447 people that actually needed subsidies to get health insurance. 81 00:04:07,513 --> 00:04:10,950 It was never designed to go to 400% of the poverty level. 82 00:04:11,117 --> 00:04:13,653 That's where it's at, and that's what's going to change. 83 00:04:13,653 --> 00:04:16,990 So Carolee, there going to be some big disruptions in the marketplace. 84 00:04:16,990 --> 00:04:17,724 Huge, huge, huge. 85 00:04:17,724 --> 00:04:22,228 And just to reiterate, American Rescue Plan was enacted in 2021. 86 00:04:22,562 --> 00:04:25,932 So they had basically, like you said, enhanced subsidies. 87 00:04:26,132 --> 00:04:29,769 So they really weren't like true to what they were prior to. 88 00:04:30,003 --> 00:04:34,507 So with that, now if anybody doesn't know what subsidies are, that's monies 89 00:04:34,540 --> 00:04:39,245 that the government gives to the carrier on your behalf for part of that premium. 90 00:04:39,412 --> 00:04:43,950 So your premium then is decreased because of the subsidy that you 91 00:04:44,017 --> 00:04:46,052 that they're giving to the carrier. Okay. 92 00:04:46,052 --> 00:04:52,158 So currently enhanced subsidies are scheduled to expire at the end of 2025. 93 00:04:52,325 --> 00:04:53,293 So what does that mean? 94 00:04:53,293 --> 00:04:58,231 That means starting in 2026, millions could see just a huge jump, 95 00:04:58,231 --> 00:05:02,035 an increase in the marketplace plans because their subsidy will go down. 96 00:05:02,368 --> 00:05:07,473 And so, so from there you have a decreased financial assistance. 97 00:05:07,607 --> 00:05:10,743 So and then from there what do you do from there? 98 00:05:11,044 --> 00:05:13,980 You've got to come to one of us so that we can figure out 99 00:05:13,980 --> 00:05:17,984 how to pivot or be able to look at other companies. 100 00:05:17,984 --> 00:05:22,188 You may end up having to not have the exact doctor you want if you're going, 101 00:05:22,388 --> 00:05:23,623 if you can afford something 102 00:05:23,623 --> 00:05:27,493 that has a more narrow network, you're going to have to probably do that. 103 00:05:27,627 --> 00:05:30,630 Aetna is also dropping out of that market. 104 00:05:30,763 --> 00:05:32,131 1 million people. 105 00:05:32,131 --> 00:05:35,535 Well, yeah, 10,000 members in the metro here. 106 00:05:35,535 --> 00:05:36,369 So Aetna 107 00:05:38,037 --> 00:05:39,005 has 10,000. 108 00:05:39,005 --> 00:05:42,008 So and they were kind of really Saint Luke's driven. 109 00:05:42,008 --> 00:05:44,277 So you know going back we're going to have to 110 00:05:44,277 --> 00:05:47,380 look at other carriers that might contract with Saint Luke's. 111 00:05:47,847 --> 00:05:50,149 And so that's where that's where it comes for us. 112 00:05:50,149 --> 00:05:53,252 So what you and we're referring here to the Kansas City market, the show 113 00:05:53,252 --> 00:05:54,354 broadcast nationwide. 114 00:05:54,354 --> 00:05:56,622 This is happening in every market across the country. Correct. 115 00:05:56,622 --> 00:05:58,591 We're just using this as an example. 116 00:05:58,591 --> 00:06:03,930 But just moving from 400% of the poverty level back to 150 or 200%. 117 00:06:04,230 --> 00:06:07,233 That's where the big change is going to come, is I said, 118 00:06:07,266 --> 00:06:11,571 when President Obama passed this bill, it was never designed 119 00:06:11,904 --> 00:06:15,708 for that piece of the marketplace, but it was enhanced by the Biden 120 00:06:15,708 --> 00:06:19,412 administration when they moved this up to 400% of the poverty level. 121 00:06:19,412 --> 00:06:22,682 And with the huge influx of people, you have 24 million 122 00:06:22,682 --> 00:06:25,685 people on these plans now that's going to change. 123 00:06:26,052 --> 00:06:28,755 And what's happening is so let me give you 124 00:06:28,755 --> 00:06:31,758 some examples of a couple things to kind of put this in perspective. 125 00:06:32,024 --> 00:06:35,595 If you're a 52 year old male, but I'll use an example of a realtor 126 00:06:35,595 --> 00:06:40,266 here in Leawood, Kansas, 52 year old male wife, the same age, one child 127 00:06:40,733 --> 00:06:44,270 made way too much money to get a subsidy, make him a significant 128 00:06:44,270 --> 00:06:46,506 salary, is a very successful realtor. 129 00:06:46,506 --> 00:06:50,843 His premium is $3,100 a month, $3,100 a month. 130 00:06:51,110 --> 00:06:54,046 He moved to a GigCare plan. 131 00:06:54,046 --> 00:06:57,350 Okay, which is the plan offered by Detego. 132 00:06:57,750 --> 00:07:01,921 Okay, a GigCare plan for $1,300 a month. Why? 133 00:07:02,221 --> 00:07:03,256 Because we're 134 00:07:04,290 --> 00:07:07,093 competing in the marketplace in a different way. 135 00:07:07,093 --> 00:07:10,029 What's happening is that people that aren't getting 136 00:07:10,029 --> 00:07:13,466 subsidies are going off these plans because they become unaffordable. 137 00:07:13,800 --> 00:07:15,435 Right. And then what's going to happen? 138 00:07:15,435 --> 00:07:18,504 What's starting to happen now is what we call a death spiral. 139 00:07:18,771 --> 00:07:21,808 You're going to and this is being referred to in the media 140 00:07:21,808 --> 00:07:25,044 in a lot of places, the healthy people are coming off the plans. 141 00:07:25,077 --> 00:07:26,512 Yes they are. 142 00:07:26,512 --> 00:07:28,981 They're going to look for alternatives like GigCare. 143 00:07:28,981 --> 00:07:31,851 They're going to look for alternatives on the group side like ICHRA. 144 00:07:31,851 --> 00:07:34,554 And we'll talk with Maria about that a little later on. 145 00:07:34,554 --> 00:07:35,054 Okay. 146 00:07:35,054 --> 00:07:38,424 But there are marketplace solutions out there that are going to come into play. 147 00:07:38,424 --> 00:07:40,593 They're going to start to change the dynamic here. 148 00:07:40,593 --> 00:07:44,597 But this all centers around the fact that this was never designed, 149 00:07:45,064 --> 00:07:47,867 okay, to be a completely government run system. 150 00:07:47,867 --> 00:07:50,069 Oh, are there are people that wanted that? 151 00:07:50,069 --> 00:07:51,037 You bet there are. 152 00:07:51,037 --> 00:07:54,373 The, you know, the group people in this country that want Medicare for all. 153 00:07:54,373 --> 00:07:57,510 And they think that solution, that's where they were hoping this is going to go. 154 00:07:57,510 --> 00:07:58,978 What they didn't count on 155 00:07:58,978 --> 00:08:01,514 was that the Trump administration was going to come in 156 00:08:01,514 --> 00:08:04,884 and they were going to change this back to what it was originally meant to be. 157 00:08:05,017 --> 00:08:07,053 So that's where we're at. Okay. 158 00:08:07,053 --> 00:08:10,923 And then when I come back from the break, I'm going to talk with two experts now, 159 00:08:11,190 --> 00:08:14,460 and we're going to start talking about what can you do to prepare yourself. 160 00:08:14,727 --> 00:08:16,762 I don't care where you're at in the country. 161 00:08:16,762 --> 00:08:17,797 This is happening. 162 00:08:17,797 --> 00:08:18,331 Okay. 163 00:08:18,331 --> 00:08:23,870 So what can you do to prepare yourself so that you're not caught up in a trap 164 00:08:23,870 --> 00:08:26,873 and you can't make a decision to solve the problem? 165 00:08:26,873 --> 00:08:28,774 That's going to make sense for you economically, 166 00:08:28,774 --> 00:08:31,110 and going to give you the kind of coverage you need. 167 00:08:31,110 --> 00:08:33,012 That's what we're talking about here today, 168 00:08:33,012 --> 00:08:34,814 and that's the message we're trying to get out to. 169 00:08:34,814 --> 00:08:36,816 Everyone is be prepared. 170 00:08:36,816 --> 00:08:37,783 This is coming. 171 00:08:37,783 --> 00:08:39,685 It's going to be like a tsunami. 172 00:08:39,685 --> 00:08:40,887 There going to be a lot of people 173 00:08:40,887 --> 00:08:43,890 displaced off of these plans are going to be looking for alternatives. 174 00:08:44,090 --> 00:08:46,559 And so how do you deal with that? 175 00:08:46,559 --> 00:08:48,094 What's the best solution for that? 176 00:08:48,094 --> 00:08:49,896 That's what we're here to talk about today 177 00:08:49,896 --> 00:08:53,633 and show you how you can do that and make sense of it for you, your family. 178 00:08:53,633 --> 00:08:56,235 If you're an employer, what do you need to be looking at? 179 00:08:56,235 --> 00:08:59,338 Because the ACA plans for small group are going to get hit 180 00:08:59,338 --> 00:09:02,341 hard, it just as hard as the individual plans are. 181 00:09:02,341 --> 00:09:04,010 It's not harder in some cases. 182 00:09:04,010 --> 00:09:05,945 So how are you going to prepare for that? 183 00:09:05,945 --> 00:09:08,114 Stay tuned. We'll be right back after the break. 184 00:09:08,114 --> 00:09:10,650 You're listening to America's Healthcare Advocate 185 00:09:10,650 --> 00:09:13,653 Broadcasting here on the HIA Radio Network. 186 00:09:13,753 --> 00:09:15,555 Coast to coast across the USA. 187 00:09:15,555 --> 00:09:16,789 Stay right there. We've got more. 188 00:09:25,031 --> 00:09:28,801 To. Welcome back. 189 00:09:28,801 --> 00:09:32,371 You're listening to America's Healthcare Advocate show broadcasting coast 190 00:09:32,371 --> 00:09:36,042 to coast across the USA here on the HIA Radio Network. 191 00:09:36,208 --> 00:09:39,245 Want to say hello to our affiliate in Pensacola, Florida, 192 00:09:40,012 --> 00:09:43,783 WNRP, AM 1260 and 95.3FM. 193 00:09:43,983 --> 00:09:47,753 We're on 8:00 in the morning there on Saturday mornings in the Pensacola area. 194 00:09:48,020 --> 00:09:51,023 Happy to be part of that family in Pensacola, Florida. 195 00:09:51,257 --> 00:09:52,191 Welcome on board. 196 00:09:52,191 --> 00:09:54,560 Glad to have you. In studio with me today. 197 00:09:54,560 --> 00:09:59,165 Carolee Steele and Maria Ahlers from RPS Benefits by Design. 198 00:09:59,465 --> 00:10:03,402 We're here to talk about all the changes that are coming and they are coming, 199 00:10:03,636 --> 00:10:06,606 which is why we're doing this show today well ahead of 200 00:10:06,606 --> 00:10:09,609 what we're going to anticipate in the open enrollment period. 201 00:10:09,675 --> 00:10:13,179 The changes that are coming to ACA, we've got changes coming in Medicare. 202 00:10:13,379 --> 00:10:16,682 That's going to be a different show, but we really want to focus on ACA today, 203 00:10:16,882 --> 00:10:19,452 Obamacare, ACA. Whatever you know it as. 204 00:10:19,452 --> 00:10:23,990 Both on the small, on the small group market and on the individual market. 205 00:10:24,123 --> 00:10:26,225 How is it going to impact what's it going to look like? 206 00:10:26,225 --> 00:10:30,029 So I'm going to roll through some of the numbers here just to give you some idea. 207 00:10:30,363 --> 00:10:32,031 So these are the carriers. 208 00:10:32,031 --> 00:10:33,766 We're just going to use the KC metro. 209 00:10:33,766 --> 00:10:35,801 But again I'm doing this. 210 00:10:35,801 --> 00:10:38,170 So it's a you know, it's a microcosm of what's going on. 211 00:10:38,170 --> 00:10:40,006 But this is going on around the country. 212 00:10:40,006 --> 00:10:41,941 I'm just using this example. 213 00:10:41,941 --> 00:10:45,878 So Celtic Insurance is going to have a 24.4% increase. 214 00:10:46,178 --> 00:10:49,915 Medica insurance 29.2% increase 215 00:10:50,216 --> 00:10:53,319 Oscar 11.7% increase. 216 00:10:53,552 --> 00:10:55,888 United Health Care 10.7. 217 00:10:55,888 --> 00:10:57,423 Guess what? 218 00:10:57,423 --> 00:11:01,527 Blue Cross and Blue Shield of Kansas City -4.4 219 00:11:01,861 --> 00:11:06,966 I'm going to repeat that blue Cross and Blue shield of Kansas City -4.4. 220 00:11:07,199 --> 00:11:07,933 So Blue Cross 221 00:11:07,933 --> 00:11:11,470 Blue Shield of Kansas City is coming in with a different plan in the marketplace. 222 00:11:11,470 --> 00:11:13,606 We're going to talk about that is the solution. 223 00:11:13,606 --> 00:11:16,809 But to give you an idea there's a lot of disruption coming up. 224 00:11:16,842 --> 00:11:19,011 And when people lose these subsidies 225 00:11:19,011 --> 00:11:20,846 you know, how are they going to respond to that? 226 00:11:20,846 --> 00:11:22,048 How is that going to work? 227 00:11:22,048 --> 00:11:23,049 Well, when you're looking 228 00:11:23,049 --> 00:11:26,852 at these kinds of increases which have nothing to do with the subsidies, 229 00:11:26,852 --> 00:11:28,421 these are just the increases 230 00:11:28,421 --> 00:11:32,825 based on the fact that these carriers are having claims, they're outstripping 231 00:11:33,025 --> 00:11:36,095 what they're bringing in, which is why Aetna pulled out of the market 232 00:11:36,095 --> 00:11:40,032 after losing over $2 billion last year. 233 00:11:40,666 --> 00:11:42,101 On the individual health insurance side. 234 00:11:42,101 --> 00:11:43,736 They just couldn't do it anymore. 235 00:11:43,736 --> 00:11:45,905 Okay. So you have two dynamics here. 236 00:11:45,905 --> 00:11:49,241 One is reduced subsidies, the other is increasing costs, 237 00:11:50,009 --> 00:11:52,745 that are associated with ACA 238 00:11:52,745 --> 00:11:55,481 and that's impacting the marketplace. 239 00:11:55,481 --> 00:11:58,017 So let's talk about this. So it looks like 240 00:11:59,085 --> 00:12:01,587 you're going to see significant increases across the board. 241 00:12:01,587 --> 00:12:04,290 And that to your point it's going to stack. 242 00:12:04,290 --> 00:12:06,826 So you've got increased premiums. 243 00:12:06,826 --> 00:12:09,361 And then you have lowered subsidy. 244 00:12:09,361 --> 00:12:12,465 So that's going to stack on there to where their premiums 245 00:12:12,465 --> 00:12:15,768 are going to be significantly higher because of that. 246 00:12:15,768 --> 00:12:19,505 So blue cross and blue Shield of Kansas City not unusual 247 00:12:19,805 --> 00:12:22,842 that they would be innovative and figure out a way to do this. 248 00:12:22,842 --> 00:12:26,746 The, the, you know, the individually, operated not for profit 249 00:12:26,746 --> 00:12:30,449 Blue Cross plans seem to have an ability to do things like this, right? 250 00:12:30,816 --> 00:12:32,852 Do innovative pieces. 251 00:12:32,852 --> 00:12:35,154 And so as a result of that, 252 00:12:35,154 --> 00:12:38,157 you know, here we're looking at the only one in the marketplace. 253 00:12:38,390 --> 00:12:40,826 It's going to have a -4.4. 254 00:12:40,826 --> 00:12:43,562 So talk about this new plan that they're going to offer. 255 00:12:43,562 --> 00:12:46,298 And yes, people are going to have to make some adjustments. 256 00:12:46,298 --> 00:12:48,834 But you're going to have a Blue Cross plan. 257 00:12:48,834 --> 00:12:49,702 Let's talk about that. 258 00:12:49,702 --> 00:12:54,907 And there is something to say about that with local customer service and things. 259 00:12:54,907 --> 00:12:56,842 That is a huge plus. 260 00:12:56,842 --> 00:12:59,178 So as far as like some of their plans currently 261 00:12:59,178 --> 00:13:03,349 have like a Blue Select Plus that may pivot to a Blue Select. 262 00:13:03,349 --> 00:13:06,352 So the market mean that the network is going to be a little bit less, 263 00:13:06,585 --> 00:13:08,287 but the premium is also going to be less. 264 00:13:08,287 --> 00:13:12,091 So you have to kind of look to see who are your non-negotiable doctors 265 00:13:12,091 --> 00:13:15,661 and who do you want what where can you kind of sacrifice 266 00:13:15,661 --> 00:13:16,962 as far as going elsewhere. 267 00:13:16,962 --> 00:13:19,532 So you're going to see access narrowed. 268 00:13:19,532 --> 00:13:21,767 So you're going to have a narrow network okay. 269 00:13:21,767 --> 00:13:22,902 But you're still going 270 00:13:22,902 --> 00:13:26,005 to have a great benefits program, but you're going to have to it, 271 00:13:26,071 --> 00:13:29,408 you know, you may have to make a change in doctors to stay in that network. 272 00:13:29,809 --> 00:13:35,281 The Blue Select and Blue Select Plus are still pretty robust, except for 273 00:13:36,081 --> 00:13:38,617 but the new new one that they're coming out with 274 00:13:38,617 --> 00:13:41,687 has a very narrow network, but a very low premium. 275 00:13:41,954 --> 00:13:44,790 And so that is kind of they're innovative, you know, 276 00:13:44,790 --> 00:13:47,760 to be able to add something to the market because they know this is coming. 277 00:13:47,893 --> 00:13:50,996 They know that people, you know, are going to be kind of 278 00:13:51,130 --> 00:13:54,900 with those enhanced subsidies going away, they're going to have sticker shock 279 00:13:55,100 --> 00:13:55,568 for sure. 280 00:13:55,568 --> 00:13:58,604 And so that's why they've developed this new plan, you know, and 281 00:13:58,604 --> 00:14:01,707 so they're going to be able to offer other options. 282 00:14:01,774 --> 00:14:04,977 So that's one solution that's going to be in the marketplace. 283 00:14:04,977 --> 00:14:06,946 Let's talk about another one. 284 00:14:06,946 --> 00:14:08,614 GigCare which is offered by Detego. 285 00:14:08,614 --> 00:14:13,118 I gave the example in the opening monologue about the real estate 286 00:14:13,118 --> 00:14:13,652 broker here. 287 00:14:13,652 --> 00:14:18,290 So if you're making 150, 200 and $300,000 a year, I know 288 00:14:18,290 --> 00:14:19,725 there are a lot of you out there to do. 289 00:14:20,726 --> 00:14:23,395 And you can afford to do something different. 290 00:14:23,395 --> 00:14:26,131 Maybe you don't want to pay $3,100 a month for three 291 00:14:26,131 --> 00:14:29,134 people on plan, and you come to a plan like GigCare. 292 00:14:29,301 --> 00:14:33,172 This is designed specifically for 1099 people or. 293 00:14:33,172 --> 00:14:37,443 W2 people that do not have coverage offered, you know, from their company. 294 00:14:37,443 --> 00:14:39,578 So they do not or their wife. Yes. Right. 295 00:14:39,578 --> 00:14:43,515 So there there is a solution, that is significantly different. 296 00:14:43,549 --> 00:14:43,949 Correct. 297 00:14:43,949 --> 00:14:49,788 And the all of the marketplace plans, well, at least in the KC Metro, 298 00:14:49,788 --> 00:14:53,592 but very much, across the nation as well, are EPO's. 299 00:14:53,893 --> 00:14:56,362 That's exclusive provider organizations. 300 00:14:56,362 --> 00:15:01,300 So there is no network outside of, you know, 301 00:15:01,300 --> 00:15:04,003 you don't have to have like an HMO, you don't have to have referrals, 302 00:15:04,003 --> 00:15:08,374 but there's no out of network coverage except for emergency. 303 00:15:08,641 --> 00:15:11,877 And so that's where GigCare, you know, they have those, 304 00:15:11,877 --> 00:15:13,078 but they've got Blue Card. 305 00:15:13,078 --> 00:15:16,682 So anywhere you go in the United States 306 00:15:16,682 --> 00:15:20,319 that offers like Preferred Care Blue, etc., you can go to those doctors. 307 00:15:20,552 --> 00:15:22,688 I have people that travel to Florida. 308 00:15:22,688 --> 00:15:24,123 They're doctors are in there. 309 00:15:24,123 --> 00:15:27,893 Here, their doctors are in there and that's huge because, 310 00:15:28,627 --> 00:15:32,698 those EPO's, especially with restricted networks, are going to make a difference, 311 00:15:32,698 --> 00:15:33,933 that you're going to have to pivot 312 00:15:33,933 --> 00:15:36,302 and look elsewhere to see how you can get covered. 313 00:15:36,302 --> 00:15:41,006 So the GigCare plans have an EPO model and they have a straight PPO model. 314 00:15:41,006 --> 00:15:43,909 And you're referring to the PPO model is the Blue Card model, 315 00:15:43,909 --> 00:15:46,312 which is anywhere in the country by the way, 316 00:15:46,312 --> 00:15:49,048 you may not know this yet, so I'll announce that here on this show, 317 00:15:49,048 --> 00:15:51,317 we are now going to have the Aetna network. 318 00:15:51,317 --> 00:15:54,386 And the Cigna network is options under GigCare. 319 00:15:54,687 --> 00:15:58,257 So it'll be an option for Aetna, Cigna and Blue Cross and Blue Shield 320 00:15:58,590 --> 00:16:00,626 which is going to make a big difference right. 321 00:16:00,626 --> 00:16:03,696 Even if you have an EPO though like if you're like we're 322 00:16:03,696 --> 00:16:06,699 in the Kansas City metro, it's Blue Cross and Nebraska network. 323 00:16:06,932 --> 00:16:09,735 So Blue Card will go anywhere here. 324 00:16:09,735 --> 00:16:14,106 So even though it's a PPO and EPO, there's a little more flexibility 325 00:16:14,273 --> 00:16:18,177 as far as a network is designed when you're outside with that Blue Card. 326 00:16:18,410 --> 00:16:21,413 So again you know you're seeing some differences here. 327 00:16:21,714 --> 00:16:22,982 There are solutions out there. 328 00:16:22,982 --> 00:16:25,951 You're looking at the solution here from Blue Cross Blue Shield to Kansas City. 329 00:16:26,085 --> 00:16:28,087 We're talking about this GigCare solution. 330 00:16:28,087 --> 00:16:29,221 When we come back from the break 331 00:16:29,221 --> 00:16:33,158 I'm going to talk to Maria Ahlers about a small group solution called ICHRA. 332 00:16:33,392 --> 00:16:34,360 What does that mean. 333 00:16:34,360 --> 00:16:37,229 How does that work? How can that benefit employers? 334 00:16:37,229 --> 00:16:38,397 So we'll talk about that 335 00:16:38,397 --> 00:16:40,566 and some of the other plans that are out there 336 00:16:40,566 --> 00:16:42,601 that are a little different in their model, 337 00:16:42,601 --> 00:16:46,338 but still offer good coverage for people so they can get these cost 338 00:16:46,338 --> 00:16:48,207 controls in line and make sense out of it. 339 00:16:48,207 --> 00:16:52,578 So I think there are solutions, but they're just not going to be 340 00:16:52,578 --> 00:16:55,614 the solutions that have been out there for the last five years. 341 00:16:55,614 --> 00:16:59,351 And if you're a lazy broker and you don't want to get off your rear end 342 00:16:59,618 --> 00:17:03,422 and look at some of the other options, you can't just put this spreadsheet down 343 00:17:03,422 --> 00:17:05,190 and say, here's, here's all, here's the deal. 344 00:17:05,190 --> 00:17:10,262 Cross United, Cigna, Aetna (no longer) but plans and pick your poison. 345 00:17:10,295 --> 00:17:13,298 You have to you have to be innovative enough to look at opportunities. 346 00:17:13,365 --> 00:17:16,201 You just have to look outside the box and see what there is out there. 347 00:17:16,201 --> 00:17:18,971 And that's where we come into play. And that's what these folks do. 348 00:17:18,971 --> 00:17:21,974 I don't care where you're at in the country if you need help. 349 00:17:22,041 --> 00:17:27,279 877-385-2224 ask for the lovely Carolee Steele 350 00:17:27,279 --> 00:17:29,882 if it’s on the ACA side or the Medicare side. 351 00:17:29,882 --> 00:17:31,850 If it's on the group side, 352 00:17:31,850 --> 00:17:34,586 Maria Ahlers can certainly help you, or are one of the other folks 353 00:17:34,586 --> 00:17:36,655 there will be happy to help you on the group side. 354 00:17:36,655 --> 00:17:38,791 But they can make a difference because they're willing 355 00:17:38,791 --> 00:17:43,395 to step out of the box and look at things that are different . 356 00:17:43,395 --> 00:17:50,169 877-385-2224 or the website rpsbenefitsbydesigninc.com. 357 00:17:50,169 --> 00:17:52,604 Go to the website, send them an email if you want help. 358 00:17:52,604 --> 00:17:54,239 We'll be right back after the break. 359 00:17:54,239 --> 00:17:55,607 You're listening to America's 360 00:17:55,607 --> 00:17:59,678 Healthcare Advocate broadcasting coast to coast across the USA. 361 00:17:59,711 --> 00:18:00,512 Stay right there. 362 00:18:11,790 --> 00:18:12,458 Welcome back. 363 00:18:12,458 --> 00:18:14,393 You're listening to America's Healthcare Advocate 364 00:18:14,393 --> 00:18:17,429 show broadcasting coast to coast across the USA. 365 00:18:17,629 --> 00:18:19,731 All these shows are on our podcast platform. 366 00:18:19,731 --> 00:18:22,801 So Spotify, SoundCloud, TuneIn, you name it we’re on there. 367 00:18:22,801 --> 00:18:23,902 Rumble, all of them. 368 00:18:23,902 --> 00:18:25,037 And the YouTube channel. 369 00:18:25,037 --> 00:18:25,871 Dave Thiessen 370 00:18:25,871 --> 00:18:29,741 pulls all this together, gets it up there for you and does a great job with this. 371 00:18:29,741 --> 00:18:31,944 So you can tell somebody about this. 372 00:18:31,944 --> 00:18:35,280 Hey, maybe it's your employer and you guys are not aware 373 00:18:35,280 --> 00:18:37,850 a lot of people are not aware of what's coming. 374 00:18:37,850 --> 00:18:41,220 Have them go listen to the podcast, have them go look at the YouTube video 375 00:18:41,386 --> 00:18:44,223 so they understand what's going to happen on the employer side. 376 00:18:44,223 --> 00:18:47,226 And if it's, you know, we're talking about the individual health insurance, 377 00:18:47,459 --> 00:18:50,496 you know, if this is your husband, your wife, whatever the case may be, 378 00:18:50,762 --> 00:18:51,396 your family, 379 00:18:51,396 --> 00:18:54,399 you might want to have a conversation with them, have them take a listen to this 380 00:18:54,433 --> 00:18:55,801 and look for some alternatives. 381 00:18:55,801 --> 00:18:58,670 If you just want some help and a consultation. 382 00:18:58,670 --> 00:19:02,841 877-385-2224 ask for Carolee. 383 00:19:02,875 --> 00:19:04,443 If it's on the individual side. 384 00:19:04,443 --> 00:19:09,848 If it's on the group side to ask for Maria, callers 877-385-2224 anywhere 385 00:19:09,848 --> 00:19:13,418 in the country okay, doesn't matter where you are, they're happy to help you. 386 00:19:13,652 --> 00:19:19,324 The website is rpsBenefitsByDesignInc.com if you want to go up on the website. 387 00:19:19,525 --> 00:19:19,758 All right. 388 00:19:19,758 --> 00:19:22,761 So the the changes on verification. 389 00:19:22,761 --> 00:19:24,730 Let's get that first. And we're going to go right to group. 390 00:19:24,730 --> 00:19:25,531 Give it on okay. 391 00:19:25,531 --> 00:19:30,035 Consumers are required to verify their eligibility for a subsidized plan 392 00:19:30,302 --> 00:19:31,303 each year now. 393 00:19:31,303 --> 00:19:33,839 Or they have an additional $5 monthly premium. 394 00:19:33,839 --> 00:19:36,275 And that's new versus previous years. 395 00:19:36,275 --> 00:19:42,181 And also they have to verify prior to their, plan 396 00:19:42,181 --> 00:19:45,918 starting that they have a proof of a qualified life event. 397 00:19:45,918 --> 00:19:47,619 Like if you're losing employer coverage, 398 00:19:47,619 --> 00:19:51,890 you have to provide proof first before the plan will start, not after. 399 00:19:51,957 --> 00:19:52,257 Okay. 400 00:19:52,257 --> 00:19:55,561 So this is this has been coming for some time because we had people. 401 00:19:56,328 --> 00:19:59,331 I did a piece on this when I was, when I did the Medicare show. 402 00:19:59,431 --> 00:20:02,701 You've got people on the ACA plan that are getting big subsidies. 403 00:20:02,701 --> 00:20:06,872 And they're also over here on the Medicaid plan, two plans, same person. 404 00:20:06,872 --> 00:20:07,439 Okay. 405 00:20:07,439 --> 00:20:09,341 So there's a lot of fraud and waste going on here 406 00:20:09,341 --> 00:20:12,411 because they weren't verifying anything that's changing. 407 00:20:12,411 --> 00:20:13,445 Correct? Okay. They're 408 00:20:14,479 --> 00:20:17,049 going back to the way it was originally set up, 409 00:20:17,049 --> 00:20:17,583 which when you 410 00:20:17,583 --> 00:20:21,353 originally went on to an ACA plan, you had to present your tax return 411 00:20:21,553 --> 00:20:22,621 to get a subsidy. 412 00:20:22,621 --> 00:20:26,658 Well, when they opened this up in 2021, the all the rules went away 413 00:20:26,825 --> 00:20:28,594 and it flooded this place. 414 00:20:28,594 --> 00:20:30,896 That's why you got 24 million people on here now. 415 00:20:30,896 --> 00:20:34,066 And there's going to be some shock and awe as a result of the changes. 416 00:20:34,366 --> 00:20:35,767 All right. Let's switch gears. 417 00:20:35,767 --> 00:20:38,770 So the small employer is the one that gets punished the most, Maria. 418 00:20:39,738 --> 00:20:41,773 In this marketplace, you know, 419 00:20:41,773 --> 00:20:44,943 the big employers 100 lives and above, we were talking about on break. 420 00:20:44,943 --> 00:20:48,480 You can go to the Pareto Captive, you can go to Berkeley, you can, you know, 421 00:20:48,480 --> 00:20:51,683 go to one of our plans on Detego that are in the captive model. 422 00:20:51,683 --> 00:20:54,219 And you can lower your costs and make a lot of sense. 423 00:20:54,219 --> 00:20:58,824 The small employer, those 50 and below they’re other ones are getting clobbered. 424 00:20:59,024 --> 00:21:02,995 What are the solutions to them like ICHRA and you talk about some of those. 425 00:21:02,995 --> 00:21:04,863 Absolutely correct. Yes. 426 00:21:04,863 --> 00:21:09,134 There are creative solutions outside of what we call the BUCAs, right. 427 00:21:09,134 --> 00:21:12,271 The Blue Cross, Blue Shield, United, Cigna and Humana. 428 00:21:12,871 --> 00:21:14,806 ICHRA, as you mentioned, Cary. 429 00:21:14,806 --> 00:21:19,011 ICHRA stands for Individual Coverage Health Reimbursement Arrangement. 430 00:21:19,211 --> 00:21:22,981 And what that provides is instead, when you're on a 431 00:21:22,981 --> 00:21:26,518 when you're on one of the big BUCA plans, 432 00:21:27,486 --> 00:21:29,421 your employer contributes, 433 00:21:29,421 --> 00:21:32,624 at least 50% to the premium. 434 00:21:33,225 --> 00:21:36,228 What small business employers are doing is 435 00:21:37,362 --> 00:21:39,431 sometimes that's a huge cost for them. 436 00:21:39,431 --> 00:21:43,201 When they have to pay at least 50%, most of them will pay more because 437 00:21:43,201 --> 00:21:44,836 they want to be competitive in the market. 438 00:21:44,836 --> 00:21:48,974 So now what they're doing is we're looking at ICHRA where the employer 439 00:21:48,974 --> 00:21:53,612 sets a percentage or a flat rate of what they want to contribute 440 00:21:53,845 --> 00:21:56,882 to an employee for their premium health care. 441 00:21:57,349 --> 00:22:00,452 Now, what that employee does is that employee then takes that amount. 442 00:22:00,452 --> 00:22:05,857 So say your employer wanted to contribute $300 a month to your premium. 443 00:22:06,291 --> 00:22:09,461 You now have $300 a month to go on your own 444 00:22:09,728 --> 00:22:12,731 and find your own plan. 445 00:22:12,931 --> 00:22:14,132 We can help do that. 446 00:22:14,132 --> 00:22:18,770 We have partnerships where we will set it up on a platform, 447 00:22:19,471 --> 00:22:23,608 with the amount that the employer wants to to contribute. 448 00:22:23,608 --> 00:22:27,212 Then the employee goes on to the platform, they know they have the $300. 449 00:22:27,446 --> 00:22:31,450 They can shop with different carriers with different plans. 450 00:22:31,450 --> 00:22:31,950 They can pick 451 00:22:32,951 --> 00:22:34,519 the amount of their deductible. 452 00:22:34,519 --> 00:22:37,522 They can do the PPO, they can do a high deductible health plan, 453 00:22:37,889 --> 00:22:41,526 and then they can enroll and they can see what their coverage is. 454 00:22:41,526 --> 00:22:44,529 And then that $300 is contributed to their 455 00:22:44,763 --> 00:22:47,332 monthly rate, and then the rest is taken care of by the employee. 456 00:22:47,332 --> 00:22:51,103 So the beauty of this is instead of painting everybody with one brush, right. 457 00:22:51,403 --> 00:22:54,840 So you got employees that are 25 years old and you got employees 458 00:22:54,840 --> 00:22:57,843 that are 60 years old and they're all on the same plan. 459 00:22:58,110 --> 00:23:01,346 Well, now they don't all need the same plan. 460 00:23:01,346 --> 00:23:04,349 No 60 year old doesn't need maternity benefits, 461 00:23:04,483 --> 00:23:07,018 and they don't need access to children's mercy. 462 00:23:07,018 --> 00:23:10,522 So for them to go to this new narrow network Blue Cross plan 463 00:23:10,522 --> 00:23:12,891 maybe would make a lot of sense. Okay. 464 00:23:12,891 --> 00:23:16,128 But in order to navigate that, they have to understand what it is. 465 00:23:16,128 --> 00:23:20,031 And that's where you all come in and say to the employer, hey, 466 00:23:20,665 --> 00:23:22,367 you, you put the subsidy together. 467 00:23:22,367 --> 00:23:25,036 We'll handle getting your people on the plans they need to be on. 468 00:23:25,036 --> 00:23:25,871 Right? That's right. 469 00:23:25,871 --> 00:23:28,840 You tell us how much you can afford within your budget. 470 00:23:28,840 --> 00:23:31,676 We set it up and then your employees go on there, 471 00:23:31,676 --> 00:23:35,781 and the plans are on there for them to see, from different carriers, 472 00:23:35,781 --> 00:23:40,252 different amounts, the network, and they pick what works for them. 473 00:23:40,352 --> 00:23:41,653 See you. 474 00:23:41,653 --> 00:23:44,523 I, I've said this is the thing I've used on this show 475 00:23:44,523 --> 00:23:47,793 for years, size 44 overcoat doesn't fit everybody. 476 00:23:48,026 --> 00:23:51,062 Okay, so this is exactly what I'm talking about. 477 00:23:51,229 --> 00:23:54,599 That gives the employer a fixed cost. 478 00:23:54,933 --> 00:23:56,201 That's the whole idea. 479 00:23:56,201 --> 00:23:59,371 And it gives the employee the freedom to go pick what they want. 480 00:23:59,604 --> 00:24:01,706 That's right. That's exactly. It makes a lot of sense. 481 00:24:01,706 --> 00:24:02,774 It does. 482 00:24:02,774 --> 00:24:05,744 And then the employees, if they need 483 00:24:05,744 --> 00:24:08,480 help deciding what plan works for them, 484 00:24:08,480 --> 00:24:12,417 that's where my team comes in and provides that individual consulting. 485 00:24:12,651 --> 00:24:16,688 Now, with RPS we also work with Carolee, where 486 00:24:16,955 --> 00:24:19,691 if we feel that 487 00:24:19,691 --> 00:24:23,028 an ACA plan may be more beneficial for them, 488 00:24:23,161 --> 00:24:26,565 then we'll refer them over to that to our Solutions team to do that. 489 00:24:27,232 --> 00:24:29,568 But it's a one stop shop, Cary. 490 00:24:29,568 --> 00:24:32,804 We'll figure out what the best plan is for your employees. 491 00:24:32,804 --> 00:24:33,104 Yeah. 492 00:24:33,104 --> 00:24:36,608 Don't you know, don't try to negotiate this yourself, okay? 493 00:24:36,608 --> 00:24:38,376 It's complicated. Believe me. 494 00:24:38,376 --> 00:24:40,111 I've been doing this for 30 years, 495 00:24:40,111 --> 00:24:42,781 and it's getting more complicated, not less complicated, 496 00:24:42,781 --> 00:24:45,750 because you got government right in the middle of this now, 497 00:24:45,951 --> 00:24:49,254 and trying to sort through all this to make sense out of it in the marketplace 498 00:24:49,454 --> 00:24:50,288 is difficult. 499 00:24:50,288 --> 00:24:52,457 Here's some other solutions that people are doing. 500 00:24:52,457 --> 00:24:56,628 We've got we've got some new direct primary care clinics here in Kansas City. 501 00:24:56,928 --> 00:24:59,130 Exemplar Care is part of Hy-Vee. 502 00:24:59,130 --> 00:25:01,066 They're opening up new clinics here. 503 00:25:01,066 --> 00:25:06,271 So what we're seeing is employers saying, you know what, I'm going to buy 504 00:25:06,538 --> 00:25:11,142 that direct primary care, unlimited access for my employee and their family. 505 00:25:11,610 --> 00:25:16,715 It's $91 a month, let's say, and then I'll go buy a high deductible plan. 506 00:25:17,148 --> 00:25:19,985 Let's talk about how would you marry those two up, like, 507 00:25:19,985 --> 00:25:24,322 because I know you're doing this, the HRA and the HSA talk about that, Maria. 508 00:25:24,322 --> 00:25:27,325 Yes, we can we can pick 509 00:25:27,692 --> 00:25:32,197 pieces from different, plans to make it work for our clients. 510 00:25:32,497 --> 00:25:34,966 So you can do a, as you mentioned, care. 511 00:25:34,966 --> 00:25:39,871 You can do a direct provider membership for, for every day to day, 512 00:25:39,871 --> 00:25:43,275 you know, the ear infections, the preventative, 513 00:25:43,275 --> 00:25:46,444 the annual wellness that could be for that. 514 00:25:47,312 --> 00:25:50,782 There are also providers that are there's also programs 515 00:25:50,782 --> 00:25:54,152 where you can do that virtually now and you just pay a monthly fee, 516 00:25:54,152 --> 00:25:58,123 and it covers all their day to day stuff as well as well as prescription. 517 00:25:58,657 --> 00:26:02,360 But then we can also offer what we call catastrophic plans, 518 00:26:02,527 --> 00:26:07,098 where if somebody gets diagnosed with a major medical condition, 519 00:26:07,132 --> 00:26:11,403 then you have the catastrophic coverage that can also help cover that. 520 00:26:12,037 --> 00:26:14,806 There's HRA where, employers can pay 521 00:26:14,806 --> 00:26:18,376 for first dollar coverage, or they can pay for the back end coverage. 522 00:26:18,510 --> 00:26:21,146 There's a HSA account we've heard, actually. 523 00:26:21,146 --> 00:26:23,415 Now people are 524 00:26:24,382 --> 00:26:28,053 very much a proponent of HSA 525 00:26:28,053 --> 00:26:31,656 where they're saving 20 to $30,000 already to 526 00:26:32,857 --> 00:26:35,393 cover their medical expenses. 527 00:26:35,393 --> 00:26:39,397 There is GigCare to help with the solutions? 528 00:26:39,397 --> 00:26:42,400 There's level funded. 529 00:26:42,634 --> 00:26:46,004 Most companies now are trying to get away from the ACA 530 00:26:46,004 --> 00:26:49,007 because they are they are age rated. 531 00:26:49,074 --> 00:26:51,776 Are they are set 532 00:26:51,776 --> 00:26:55,080 And you're going to see your employers that 533 00:26:55,313 --> 00:26:58,583 when you've got reasonably healthy groups are going to start looking for a way out. 534 00:26:58,583 --> 00:26:59,050 That's right. 535 00:26:59,050 --> 00:27:00,151 They want to get off. 536 00:27:00,151 --> 00:27:02,854 They want they've got to find something that works. 537 00:27:02,854 --> 00:27:05,557 This thing is not sustainable the way it is now. 538 00:27:05,557 --> 00:27:09,794 But as a broker you have to be willing to step outside the box. 539 00:27:10,428 --> 00:27:14,265 Yet be willing to listen to what somebody is dealing with. 540 00:27:14,532 --> 00:27:15,900 How do I solve the problem. 541 00:27:15,900 --> 00:27:17,869 And here's the set of solutions. 542 00:27:17,869 --> 00:27:20,138 There's so many solutions we can 543 00:27:21,272 --> 00:27:21,906 implement. 544 00:27:21,906 --> 00:27:27,112 You know, we've done a gap plan to help with the larger, 545 00:27:27,479 --> 00:27:31,983 high deductible health plans where we add that as a plan for our clients. 546 00:27:32,684 --> 00:27:37,656 And that helps cover the gap between the deductible between the two plans. 547 00:27:38,223 --> 00:27:40,692 There's just a lot of creative solutions. 548 00:27:40,692 --> 00:27:45,096 We just need to know what your needs are, what your pain points 549 00:27:45,096 --> 00:27:48,099 are, and let's get together and figure out the different options. 550 00:27:48,133 --> 00:27:49,868 Here's the thing, okay? 551 00:27:49,868 --> 00:27:52,871 You have to be, you've got to be proactive here. 552 00:27:53,071 --> 00:27:58,309 Don't wait until you know renewal hits you with a 25% increase. 553 00:27:58,309 --> 00:28:03,715 Or a 29% increase from Medica or Celtic or one of the other ones. 554 00:28:03,715 --> 00:28:05,984 Okay, now's the time to act. 555 00:28:05,984 --> 00:28:09,854 Start a consultation, give them a call, get ahold of Maria. 556 00:28:09,854 --> 00:28:11,122 Get Ahold of Carolee. 557 00:28:11,122 --> 00:28:13,892 877-385-2224. 558 00:28:13,892 --> 00:28:17,529 It doesn't cost you anything to talk to these folks, okay? 559 00:28:17,729 --> 00:28:20,765 And they can help you get a solution. 560 00:28:20,899 --> 00:28:23,835 That's going to make sense, but you have to get in front of it, not do it. 561 00:28:23,835 --> 00:28:26,805 At the end of the situation where now you've got to renewal 562 00:28:26,805 --> 00:28:29,274 and you don't have any time to make a decent decision. 563 00:28:29,274 --> 00:28:32,644 So once again, 877-385-2224 564 00:28:32,844 --> 00:28:36,414 or their website RPSBenefitsbyDesignInc.com. 565 00:28:36,414 --> 00:28:39,250 rpsbenefitsbydesigninc.com. 566 00:28:39,250 --> 00:28:43,588 When I come back we're going to explain HSAs so you understand how they work 567 00:28:43,788 --> 00:28:48,359 and these HRAs and how you can incorporate those and keep benefits 568 00:28:48,626 --> 00:28:53,198 for a major network, but have that benefit if you have a catastrophic illness. 569 00:28:53,364 --> 00:28:55,500 Stay tuned. We'll be right back after the break. 570 00:28:55,500 --> 00:28:57,969 You're listening to America's Healthcare Advocate 571 00:28:57,969 --> 00:29:00,972 Broadcasting here on the HIA Radio Network. 572 00:29:01,039 --> 00:29:03,241 Coast to coast across the USA. 573 00:29:09,781 --> 00:29:10,448 Welcome back. 574 00:29:10,448 --> 00:29:13,918 You're listening to America's Healthcare Advocate show, broadcasting coast 575 00:29:13,918 --> 00:29:17,522 to coast across the USA here on the HIA Radio Network. 576 00:29:17,689 --> 00:29:20,125 My producer, Mr. Garner Cowdery, behind the microphone. 577 00:29:20,125 --> 00:29:21,893 Dave Thiessen behind all the cameras. 578 00:29:21,893 --> 00:29:23,027 Putting all this together. 579 00:29:23,027 --> 00:29:26,364 For all of you out there in our audience, on our podcast channels, YouTube 580 00:29:26,364 --> 00:29:29,801 channels, and across the air on all of our terrestrial radio stations. 581 00:29:29,968 --> 00:29:34,205 In studio with me, Carolee Steele and Maria Ahlers from RPS Benefits by Design. 582 00:29:34,706 --> 00:29:37,275 We're telling you, get prepared. 583 00:29:37,275 --> 00:29:39,811 It's coming. It's going to be a tsunami. 584 00:29:39,811 --> 00:29:40,678 It's coming. 585 00:29:40,678 --> 00:29:43,615 Don't wait until you're caught up in it, okay? 586 00:29:43,615 --> 00:29:45,917 These people can help you navigate through. 587 00:29:45,917 --> 00:29:47,485 The sky is not falling. 588 00:29:47,485 --> 00:29:49,521 It's not the end of the world, okay? 589 00:29:49,521 --> 00:29:53,224 But you've got to prepare yourself and if you're the employer, for God's 590 00:29:53,224 --> 00:29:55,360 sake, pick up the phone and give these folks a call. 591 00:29:55,360 --> 00:29:57,762 If you're an individual and you're concerned 592 00:29:57,762 --> 00:30:00,765 and maybe you're one of those Aetna people, you're losing coverage altogether. 593 00:30:00,765 --> 00:30:03,001 Okay, well, give them a call. 594 00:30:03,001 --> 00:30:04,068 They're happy to help. 595 00:30:04,068 --> 00:30:08,106 877-385-2224 they are experts. 596 00:30:08,106 --> 00:30:09,841 They do this nationally. 597 00:30:09,841 --> 00:30:10,308 Okay? 598 00:30:10,308 --> 00:30:13,278 877-385-2224 599 00:30:13,278 --> 00:30:16,681 or the website rpsbenefitsbydesigninc.com. 600 00:30:16,981 --> 00:30:21,019 You know, HSAs were introduced I don't know was it 15 years ago? 601 00:30:21,019 --> 00:30:22,787 Something like that. 602 00:30:22,787 --> 00:30:25,423 And it was a hard concept for people to grasp. 603 00:30:25,423 --> 00:30:25,757 Correct. 604 00:30:25,757 --> 00:30:28,827 But when you look at how they function versus how 605 00:30:29,360 --> 00:30:32,831 what I call the American Express Plan, where you have your American Express card, 606 00:30:32,831 --> 00:30:35,967 you don't have to you walk in and make a $10 co-pay and you're done. 607 00:30:36,301 --> 00:30:37,869 Well, those days are gone. 608 00:30:37,869 --> 00:30:40,004 Yeah, that's why the premiums are going through the roof. 609 00:30:40,004 --> 00:30:44,108 Let's talk about how the HSA works, why is it beneficial 610 00:30:44,108 --> 00:30:46,711 and why are a lot of people moving to those plans? 611 00:30:46,711 --> 00:30:49,681 Well, I think it’s wonderful. I have an HSA. 612 00:30:50,148 --> 00:30:54,886 So what HSA is, is that you can put monies away 613 00:30:54,886 --> 00:30:59,657 every year toward, it's a certain amount depending on if you are single. 614 00:30:59,657 --> 00:31:00,692 It’s up to $6,300 a year. 615 00:31:00,692 --> 00:31:03,661 Or a family, you can put that away. 616 00:31:03,661 --> 00:31:06,030 It's typically you've got to, 617 00:31:06,030 --> 00:31:08,867 everything comes out of pocket until you meet that deductible. 618 00:31:08,867 --> 00:31:10,869 And then there's a percentage for insurance. 619 00:31:10,869 --> 00:31:12,103 Typically the 620 00:31:13,338 --> 00:31:15,073 employer offers an HSA that 621 00:31:15,073 --> 00:31:20,311 is a reduced premium compared to the other standard traditional plans. 622 00:31:20,411 --> 00:31:21,946 So that was one good. 623 00:31:21,946 --> 00:31:24,549 It also, you can use that money. 624 00:31:24,549 --> 00:31:26,117 It rolls over to the following year. 625 00:31:26,117 --> 00:31:28,586 So it's not a use it or lose it at the end of the year. 626 00:31:28,586 --> 00:31:31,155 Correct, it's not a flex spending account. 627 00:31:31,155 --> 00:31:33,424 It is an HSA account. Yes. 628 00:31:33,424 --> 00:31:36,427 And this is really wonderful because if you have a family, 629 00:31:36,494 --> 00:31:39,063 your daughter needs to have her 630 00:31:39,063 --> 00:31:42,200 teeth pulled to get something for wisdom teeth pulled. 631 00:31:42,200 --> 00:31:47,005 You can use that as long as they're tax dependents in the family. 632 00:31:47,005 --> 00:31:50,375 You can use those HSA funds toward that as well. 633 00:31:50,375 --> 00:31:51,843 And here's the thing. 634 00:31:51,843 --> 00:31:54,479 When you put the money in there, it's a tax deduction. 635 00:31:54,479 --> 00:31:54,812 Right. 636 00:31:54,812 --> 00:32:00,118 So if you put $6,300 in there you just took $6,300 off of your tax liability. 637 00:32:00,118 --> 00:32:01,586 Correct. It's a tax deduction. 638 00:32:01,586 --> 00:32:04,188 That's huge. And Maria, once you hit a. 639 00:32:04,188 --> 00:32:09,961 Certain amount you can invest that money in the money market. 640 00:32:10,128 --> 00:32:12,297 I didn't know that. You can. 641 00:32:12,297 --> 00:32:13,531 So there's another option. Yeah. 642 00:32:13,531 --> 00:32:15,867 So the money stacks up. 643 00:32:15,867 --> 00:32:18,469 You get past your first year, you've got enough 644 00:32:18,469 --> 00:32:21,806 to cover the deductible coinsurance typically down the road. 645 00:32:21,806 --> 00:32:22,407 Okay. 646 00:32:22,407 --> 00:32:25,410 As you continue to add to it, you're building an account. 647 00:32:25,610 --> 00:32:28,046 And as you said you can invest that money Maria. 648 00:32:28,046 --> 00:32:30,214 So this is an opportunity individual side. 649 00:32:30,214 --> 00:32:34,185 So tax deductible going in tax free coming out. 650 00:32:34,319 --> 00:32:36,054 You can use it for more than health care. 651 00:32:36,054 --> 00:32:37,322 You can use it for dental. 652 00:32:37,322 --> 00:32:39,190 You can use it to buy glasses. 653 00:32:39,190 --> 00:32:41,426 You can use it for a host of different things right. 654 00:32:41,426 --> 00:32:43,494 You get a debit card. You have an HSA account. 655 00:32:43,494 --> 00:32:44,395 That's how it works. 656 00:32:44,395 --> 00:32:45,997 How does this work for employers? 657 00:32:45,997 --> 00:32:51,302 Now, Maria, in terms of you talked in the last segment, if you drop premiums 30%, 658 00:32:52,070 --> 00:32:54,372 the employer can afford to say, 659 00:32:54,372 --> 00:32:58,977 you know what, if you got an HSA, I'm going to go ahead and add another $100 660 00:32:58,977 --> 00:33:02,113 a month to this for your HSA account to encourage people do it. 661 00:33:02,280 --> 00:33:03,548 Does that make sense? 662 00:33:03,548 --> 00:33:07,018 There's a lot of different strategies, Cary, that we work with our clients. 663 00:33:07,018 --> 00:33:12,857 We have clients where they do, a high deductible health plan, offer an HSA, 664 00:33:12,857 --> 00:33:16,861 and then they contribute 100% to the employee's HSA to help 665 00:33:17,028 --> 00:33:20,031 with their costs up to their deductible. 666 00:33:20,098 --> 00:33:24,068 We have clients that will, embed an HRA, 667 00:33:24,235 --> 00:33:29,073 which where they'll cover again, if your deductible is $3,000, 668 00:33:29,240 --> 00:33:32,243 that employer will cover, will decide they'll cover the first, 669 00:33:32,744 --> 00:33:36,047 maybe the first 1500 of your deductible, or they'll cover the back 670 00:33:36,047 --> 00:33:37,715 1500 of your deductible. 671 00:33:37,715 --> 00:33:41,819 But these are creative strategies that we work with our clients 672 00:33:41,986 --> 00:33:44,956 to make it work for them, but yet 673 00:33:44,956 --> 00:33:48,659 provide them with comprehensive coverage for their employees. 674 00:33:49,961 --> 00:33:53,297 So yeah, there's there's it's it's all about strategy. 675 00:33:53,297 --> 00:33:57,301 And I think the point that you made earlier is we need to start on it 676 00:33:57,301 --> 00:33:58,536 proactively. 677 00:33:58,536 --> 00:34:03,007 Most employers will wait until they get their renewal. 678 00:34:03,241 --> 00:34:05,276 Well then we only got 60 days. 679 00:34:05,276 --> 00:34:07,879 And with that 60 days we have to strategize, 680 00:34:07,879 --> 00:34:12,216 look at different options, go to market, look at the financial analysis. 681 00:34:12,450 --> 00:34:16,220 The other piece to this that some of our clients don't, recognize that we've, 682 00:34:17,188 --> 00:34:21,626 put into play a lot is critical illness and accident and hospital indemnity. 683 00:34:21,893 --> 00:34:26,130 Those lines of coverage help with the medical costs as well. 684 00:34:26,664 --> 00:34:28,332 So there are ways to blend those in. 685 00:34:28,332 --> 00:34:30,768 And there those are relatively inexpensive. 686 00:34:30,768 --> 00:34:31,669 Relatively inexpensive. 687 00:34:31,669 --> 00:34:34,739 I had a cancer plan for I don't know how many years it was. 688 00:34:35,206 --> 00:34:38,743 I had a bulk cancer plan of $50,000, 689 00:34:39,043 --> 00:34:43,381 and the way it worked was, I hate Aflac, just so we all know I like ducks. 690 00:34:43,681 --> 00:34:45,950 I prefer it with orange sauce. Yes, but 691 00:34:48,319 --> 00:34:50,822 you know, I don't like the Aflac model because what they do 692 00:34:50,822 --> 00:34:53,791 is you have to send in your claims and then they reimburse you. 693 00:34:53,791 --> 00:34:56,661 The model that I had was once I was diagnosed 694 00:34:56,661 --> 00:34:59,964 with cancer, and the actual diagnosis went into the carrier. 695 00:35:00,031 --> 00:35:01,999 I got a check three days later, period. 696 00:35:01,999 --> 00:35:04,335 And you can spend it 697 00:35:04,335 --> 00:35:06,337 on whatever you like. 698 00:35:06,337 --> 00:35:06,838 Whatever I wanted. 699 00:35:06,838 --> 00:35:07,538 If wanted to go sit 700 00:35:07,538 --> 00:35:11,342 on a beach in Mexico and decide, okay, this is where I'm going to finish it up. 701 00:35:11,409 --> 00:35:11,843 That's right. 702 00:35:11,843 --> 00:35:12,910 I've got terminal cancer. 703 00:35:12,910 --> 00:35:14,879 That was my money to do what I want with. 704 00:35:14,879 --> 00:35:17,882 But that was a very inexpensive policy. 705 00:35:18,015 --> 00:35:20,251 But it gave me peace of mind. 706 00:35:20,251 --> 00:35:23,387 Because we know bills don't stop just because you're in the hospital. No. 707 00:35:23,421 --> 00:35:28,226 And to piggyback on that, as far as having your, like a critical, like, 708 00:35:28,559 --> 00:35:32,897 cancer, stroke and heart, you may have you may have a Medicare supplement. 709 00:35:32,897 --> 00:35:33,631 So you don't have 710 00:35:33,631 --> 00:35:36,634 a lot of medical out-of-pocket, but you may have to go to Mayo Clinic, 711 00:35:36,801 --> 00:35:38,302 and you're going to have to stay in a hotel, 712 00:35:38,302 --> 00:35:40,705 and you're going to have to fly there, and you're going to have to do all that. 713 00:35:40,705 --> 00:35:42,707 So that is also used. 714 00:35:42,707 --> 00:35:44,642 That money can be used for that as well. Yeah. 715 00:35:44,642 --> 00:35:47,111 So I think what we're trying to say here is we're wrapping this up today. 716 00:35:47,111 --> 00:35:49,981 And thank you both to me and Maria and Carolee. 717 00:35:49,981 --> 00:35:51,816 You know, it's great to have experts in studio 718 00:35:51,816 --> 00:35:53,885 that can really walk you through this stuff. 719 00:35:53,885 --> 00:35:58,322 It's complicated, but this is why I do these broadcasts. 720 00:35:58,589 --> 00:36:01,692 And I bring people on here that can explain this to make sense out of it. 721 00:36:01,959 --> 00:36:04,262 So you're looking for a solution? 722 00:36:04,262 --> 00:36:06,597 You heard Maria just say this. 723 00:36:06,597 --> 00:36:07,398 Here's what happens. 724 00:36:07,398 --> 00:36:10,635 Everybody waits until those renewal notices 725 00:36:10,635 --> 00:36:14,505 hit or ACA open enrollment starts and then they start calling. 726 00:36:14,772 --> 00:36:17,642 Well, you're not the only one okay. 727 00:36:17,642 --> 00:36:19,877 You know. Yeah. The phones are melting down. 728 00:36:19,877 --> 00:36:23,981 I remember doing this back when I ran Benefits by Design. 729 00:36:24,215 --> 00:36:26,250 And literally the phones would be melting down 730 00:36:26,250 --> 00:36:28,352 with people in a panic trying to get this done. 731 00:36:28,352 --> 00:36:29,820 This year's going to be worse. 732 00:36:29,820 --> 00:36:32,523 That's why I'm doing this show way ahead of time. 733 00:36:32,523 --> 00:36:33,090 Okay. 734 00:36:33,090 --> 00:36:34,559 So you know that it's coming. 735 00:36:34,559 --> 00:36:36,160 And prepare yourself. 736 00:36:36,160 --> 00:36:38,296 If you're an individual, you need help. 737 00:36:38,296 --> 00:36:42,300 Get ahold of Carolee, 877-385-2224. 738 00:36:42,466 --> 00:36:45,803 If you're an employer, you just heard Maria walk through how they do this. 739 00:36:45,970 --> 00:36:48,172 They do a full blown analysis. 740 00:36:48,172 --> 00:36:50,208 This is a come in and lay a spreadsheet down. 741 00:36:50,208 --> 00:36:52,510 They come in, they do a full blown analysis, 742 00:36:52,510 --> 00:36:54,445 come back to you with a series of solutions, 743 00:36:54,445 --> 00:36:57,048 and then you pick the one you think makes the most sense. 744 00:36:57,048 --> 00:36:58,916 That's what I'm suggesting you do. 745 00:36:58,916 --> 00:37:02,887 877-385-2224 is their phone number. 746 00:37:03,087 --> 00:37:06,724 Their website is rpsbenefitsbydesigninc.com. 747 00:37:06,958 --> 00:37:10,061 If you are one of the folks that are facing these kinds of renewals 748 00:37:10,294 --> 00:37:13,130 and what's happening, now's the time to reach out to them. 749 00:37:13,130 --> 00:37:15,933 And now I leave you with this thought from Albert Einstein, 750 00:37:15,933 --> 00:37:19,136 the one who follows the crowd they usually get no further than the crowd. 751 00:37:19,470 --> 00:37:23,741 The one who walks alone will likely find himself in places no one has ever been. 752 00:37:24,141 --> 00:37:25,876 Remember, friends it’s a funny thing about life, 753 00:37:25,876 --> 00:37:30,181 if you refuse to accept anything but the very best, you most often get it. 754 00:37:30,448 --> 00:37:33,251 Thank you for listening to America's Healthcare Advocate Show, 755 00:37:33,251 --> 00:37:38,289 broadcasting coast to coast across the USA here on the HIA Radio Network. 756 00:37:38,656 --> 00:37:40,024 Goodbye America.