Open Enrollment is Close!

If you are happy with your current health plan, feel free to skip this blogpost. If however, you are like most self-employed people and are frustrated with expensive, low benefit options then this post might be a help for you.

Two significant changes in health insurance this year are the removal of the individual mandate, meaning after January 1 2019, you will not be financially penalized for not having an ACA plan. The second change is the rollback of Short Term Medical limitations. Carriers can once again offer Short Term Medical plans for up to 360 days in most states.

This is important because Short Term Medical (STM) plans often offer benefits that are just as good as long term plans and are significantly cheaper. STMs are not for everyone, however. Here are some reasons NOT to go this route.

  1. You are planning on getting pregnant or are already expecting a child. STMs will not cover maternity benefits so don’t pick an STM if you are or think you might get pregnant.
  2. You have a chronic condition that needs regular medical care. STMs do not cover preexisting conditions in most cases so if you have expensive maintenance medications or have been informed by a doctor that you need medical attention for a condition you already have, these plans are not for you.
  3. You are planning on leaving the country for an extended period of time or have been out of the country for most of the last year. There are plans that cover international travel, but most regular STMs will not offer coverage outside the U.S..

If none of these apply to you, an STM might be a fit. In many cases these plans are 2/3 to 1/2 the price of equivalent ACA plans and generally have better doctor networks.

Something to look into!


Good Individual Health Coverage is Hard to Come By.

Individual health insurance is in a rough spot these days. Premiums, deductibles and out-of-pocket maximums are very high and doctor and facility networks are getting thinner by the month as providers are opting out of many individual plans. Some states have been hit worse than others. Some counties have only one ACA qualified plan and some have none.

a guide to big city life & love.I have clients who have watched their premiums go up and benefits go down each year for a few years now and more than ever people are looking for other options. Here’s what I tell them.

You have three categories of options:

  1. The Affordable Care Act (ACA): This includes any plan you find on or your state exchange, but often carriers will offer ACA compliant plans separate from the marketplace. Pros: These are good if you have preexisting conditions, or if you qualify for a subsidy that brings your premium down significantly. Cons: Usually these represent the most expensive, least beneficial plans and their doctor and facility networks get thinner by the month.
  2. Short Term/Indemnity plans: Indemnity plans are very inexpensive, first-dollar-coverage plans that I rarely recommend because they do not limit exposure. The better of these two options is Short Term Medical (STM) So many people have chosen the Short Term option that last year the length of terms was limited to 3 months. That ruling should be reversed in April. Pros: Short Term Medical is major medical coverage, usually with a better network of doctors and facilities than ACA plans and the cost is usually 1/3 to ½ the full price of comparable ACA plans. Cons: For 2018 you still may pay a tax penalty for having STM as they are not compliant with the mandate that doesn’t go away until 2019. Often the tax penalty combined with the savings because STMs are usually so much cheaper, still make it a less expensive. Also, STM plans can deny you for preexisting conditions so heaven forbid you develop a chronic illness. In that case you would be covered for the remaining term and might not be able to renew the policy for the next term.
  3. Health Sharing plans: These are not new, but many people are just hearing about them for the first time. They actually aren’t technically health insurance at all, but you can consider them major medical health coverage. Most of these organizations are founded as religious organizations and vary in their membership requirements. Pros: Generally less expensive and better benefits, they also keep you from paying a tax penalty as they are exempt from the mandate. Their doctor networks can be better and while some of the plans work very differently from regular health insurance, a few work very similar. Cons: Doctors and facilities are warming up to these plans, but a few still won’t take them even though they may be in network; and many of the plans have waiting periods for preexisting conditions. They also have limited drug benefits.


To summarize, the options for individual health coverage is not as robust as those with employer sponsored plans, but it’s not impossible to find coverage that meets your needs and generally you can find it cheaper by not going with an ACA plan. For most healthy people, I highly recommend looking in to health sharing plans. In my experience, the more people learn about them, the more they like them.

Two Essential Tools

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Ever wonder what a mammogram should cost? Have you ever looked at your provider’s statement and asked yourself it the charges were reasonable compared to other providers? Now you can find out.

Healthcare Bluebook ( is a great way to find out what is a fair price for procedures in your area. Their website states:

“By combining the best cost and quality data with industry-leading usability, Healthcare Bluebook provides people and organizations with everything they need to be more effective healthcare consumers. We’re forever changing the way people choose. We’re bringing fair to healthcare.”

The idea is to provide you with information that will help you decide according to both price and quality where is best to obtain healthcare.

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I have been recommending for quite some time now. It is an excellent way to find the best places to get prescriptions refilled. You don’t need a membership or a drug plan. It’s a simple search that provides you with the cheapest places to get a particular drug based on your zip code.

Good Rx ( is the best way I know to find out where to find the best price for prescription drugs in your area. Their website states:

“Most Americans assume that drug prices are regulated or fixed. That’s simply not true. Prices vary wildly in drugstores that are literally across the street from each other, especially when filling generic medications (which make up about 80% of the prescription fills in America).”

Very often I’ve found that the best price for a particular drug is less than your generic copay!

Armed with these two tools, you should have good information should you be trying to decide which carrier to choose and what doctor network or drug plan. You will have a dramatic information advantage.

Your Employees are Hurting

Unhappy manager     If you don’t provide health insurance to your employees it’s probably because you’ve decided you just can’t afford it. While it’s true that groups aren’t always cheaper there is another really important thing to consider. There is a dramatic difference between individual health insurance and group health insurance, and now more than ever. Here are 3 ways your employees will benefit from a group policy over the choices they now have on the individual marketplace:

Perhaps they really can keep their doctor.

     We all remember the famous promise that proved untrue. That’s because each carrier created separate doctor networks for their ACA Individual Marketplace plans and many doctors have opted out of those networks (or were asked to leave), in favor of other networks that offered more flexibility in managing care. For example, United Healthcare’s ACA network is called Compass Balanced whereas the network for their group plans is called Choice Plus. The Choice Plus network is considered a much better network. This applies to every major carrier in the industry. It’s more likely that your employee will find their family doctor in the Choice Plus network than the Compass Balanced.

They might save money.

Most groups are billed compositely, which means that older employees are going to benefit from being in a group with younger people. I recently wrote a group policy for a title company in Texas. One of their best employees was struggling because her husband had been diagnosed with cancer, couldn’t find an ACA plan that had MD Anderson in network, and was paying $1,800 in monthly premiums. Once the new plan was in place, MD Anderson was in network and her paycheck deduction was reduced to just over $600! Now how loyal do you think she feels about her employer?

They will typically get better benefits.

Group policies often provide benefits that you just won’t find on the individual marketplace. Nowhere is this more evident than with dental plans. I rarely recommend dental policies on the individual marketplace. The coverage is typically very limited, have long waiting periods, and simply do not cover things like orthodontia.

Most small businesses compete for the best talent and health insurance is one of the best ways to do it, especially since Obamacare has struggled to live up to the hype. Group insurance isn’t for every small company, but for some it may be the difference between keeping or losing your best people.

Overspending On Insurance

“When I give someone my insurance card, I want benefits!”
     I get it. If I had a nickel for every time I heard someone say, “Why should I pay monthly for a premium and still have to pay full price for my doctors visit or medications?” The answer to that question is a sharp pencil and a calculator.
     Remember the purpose of insurance—to manage risk—and unless we’re talking about certain life insurance products, health insurance is almost never considered an investment. It’s a sunk cost that we hope we’ll never have to use much less get a return on, because that means we’ve been really sick or injured! The goal then becomes to get the best value at the best price and to do that we have to look at more than monthly premiums. While cash flow is important to most people, it’s not the only way to judge which policy to pick. Often the most important way to judge is by looking at yearly costs, which include variables such as deductibles, coinsurance rates and maximums, and copays.  Here are some common mistakes people make when approaching health insurance:
  • Paying more for a lower deductible they will never meet.
     If you’re young and have no history of illness it rarely makes sense to pay more for a policy that has a lower deductible. If you aren’t likely to meet a $2,500 deductible, why pay more in premiums to have it that low? It’s often better to take a plan with a higher deductible, and add a supplemental policy that will pay your deductible for you. You will almost always save money and get better coverage that way.
  • Paying too much to get a plan with a copay.
     How often do you go to the doctor in a year? If it’s less than two or three times then it’s generally cheaper to take a plan without copays. Remember copays only pay for the visit—the part where the doctor takes your temperature, hammers your kneecap and asks you what’s wrong. The negotiated rate for that part of the visit can range anywhere from $150 to $250 depending on the doctor and the carrier. If you need blood work or x-rays, your copay isn’t going to cover that. This is where your calculator comes in handy. Often copay plans can cost $100/month or more than plans without copays. Lets say you go to the doctor three times a year. That means you have spent an extra $400, plus whatever your copay is for each visit. Let’s say your copay is $25. So the visit that would have only cost you $150-$250 has now cost you $425 in this scenario, and you STILL have to pay for any testing you have done. You get the idea.
  • Buying the wrong dental insurance, or buying it at all.
I imagine most agents would rarely tell you not to buy something, but in the case with dental insurance, there are not many good choices out there these days unless they are bundled with your employer’s group policy. If your teeth are healthy, have no family history of problems, and all you do is get them cleaned twice a year you’re often better off negotiating directly with your dentists for your cleanings. Most individual dental plans have waiting periods and offer very little coverage. That said there are plans available that can benefit you greatly if you know you are going to need work done.
  • Thinking that a major medical policy alone can meet all your needs.
     Supplemental policies are a great way to customize your coverage and if packaged right, can save you in monthly premiums and get you better coverage! Add an accident policy or a critical illness policy to a higher deductible plan and you will likely pay less per month. Consider a discount drug program instead of paying more for a drug copay if you don’t take tier 3 or 4 medications.
     A good agent can help you navigate your options and save you money. The best agents get paid from the insurance carriers and their services don’t cost you anything, and generally not using an agent won’t save you any money. Major carriers don’t have one price for using an agent and another for going directly to their website or through Find someone you trust and it could make all the difference next year!