The New Health Insurance Solution: How to Get Cheaper, Better Coverage Without a Traditional Employer Plan
Posted on 21. Aug, 2009 by admin in Health Insurance
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Anonymous
21. Aug, 2009
1.0 out of 5 stars
Nice Spin, but not accurate
As the director of a large group of self-employed professionals in the Pacific NW, I was extremely disappointed with this.
Humaira
21. Aug, 2009
I am a V.P. at a large Tennessee-based third have fun administrator and typically work with sizable employers (over 250 employees). My interest was in gathering more information about the individual plot market and how it works. As the title suggests, the book is loaded with surprising information about the individual plot market.
First, I have to admit that I knew very small about individual plans (other than what is available at numerous Internet quoting sites) and was shocked to see how inexpensive individual plans are in many very large states. For instance, the average price of an individual plot in California is less than $200 per month (individual plans are on a monthly contract, not annual like group). If you live in California, this is a book you should pick up to learn more about individual plot rates there. Plans here in Tennesse are a small more expensive and the author did a excellent job of explaining why plans cost less across numerous states. If you are in New Jersey or New York or Massachussetts, it is clear that you are screwed when it comes to trying to find affordable insurance for you and your family. That is because the carriers are not allowed to underwrite you and therefore have to take the crack users with the marothoners and triathletes — fantastic thinking, NY and NJ! The result? Carriers price individual plans to the moon.
Second, the HSA is an brilliant tax savings vehicle as it is one of the few government approved accounts you can place your cash in tax free, use it tax free (for medical expenses) and take it out tax free. We hegemony HSAs for many groups here in Tennessee and in North Carolina — so that was no surprise. What was surprising was the availability of individual HSAs and how inexpensive they are — again, depending on where you live. If you are self-employed, you owe it to yourself to look at an individual HSA just given how cheap the rates are. I recommend you read this book cover-to-cover and then go shop around online for plans to get the best deal.
Third, the author highlights the plight of small businesses in America and suggests that small business owners get out of the group business and go to a reimbursement model for employees to get their own shape plans. I was not aware that most US bankruptcies are caused by medical bills and not credit cards. Even more of a shocker, the majority (not remember the percentage quoted) were really on a group plot when they got sick and started encountering foremost medical bills. So much for the protections afforded by getting insurance from your employer via a group plot. Most of our clients are self-insured — which means they pay for substantial amount of their shape care costs themselves. They use us to manage their claims. In Professor Pilzer’s world, small companies would not need group insurance and would just give employees allowance to go buy what they want. An fascinating thought that a small business owner may want to consider (after getting their 3rd foremost rate increase in 3 years).
The negatives to the book are that there are so many examples and cross chapter references that you will find yourself skipping around the book pulling information from different sections on numerous occassions. There is also nearly TOO MUCH data and examples listed in the book. I realize the author wanted to support his claims (and he did), but the number of Tips and Hints was a bit overwhelming. I am in the shape care business and I found myself having to go back and review sections more than once to make sure I “got it” and the accompanying charts and tips that are found on what seemed like nearly every page.
The final unenthusiastic is a call to action to “contact your Congressman and get them to remove themselves from the government shape insurance curriculum”. Yeah, right. Like they are going to give up benefits for life. Perhaps this is why so many politicians do not know the United States shape care system — because they really are insulated from it by taking personnel and getting on some incredibly rich benefit plot. Most of my clients cannot afford such a plot and are getting priced out of the market. This book offers a “cook book” of what employers can do about it. I am not sure that bombarding your Congressman is going to have much look — they are set for life and are not like the rest of us.
The negatives are largely outweighed by the positives in the book — not the least of which is the sheer amount of information and data from real world policy purchasers — not some reckon tank guessing about what individual shape insurance really costs. If you want the most in-depth look at the US shape insurance market, look no further as I am not aware of any other book that covers the entire marketplace and provides the latest info on new Shape Savings Accounts. If you are self-employed or own a small business, this book will likely be enormously useful to you. Excellent luck.
Edsel
21. Aug, 2009
3.0 out of 5 stars
Excellent place to start educating yourself. With flaws.
First I’m FOR complete shape care. Those who gave the book low ratings because of our messed up system and blaming the author are barking up the incorrect tree.
Paco
21. Aug, 2009
Pilzer’s general proposition is that the market place will take care of the shape insurance issues in this country if we just let the free market operate. He maintains that individual shape insurance is usually available at reasonable cost and people, including employers and employees, should take advantage of the individual market for shape insurance. I believe he tends to force the facts to fit this basic proposition.
He is simple to read with a breezy style. The book has pretty excellent explanations of HIPAA and COBRA and a number of excellent tips. But, shape insurance in the United States is intricate. The price he pays for simplicity is accuracy and thoroughness. It is a pretty excellent book if you are 35, perfectly healthy, and thinking about buying insurance. But what is excellent for when you are 35 is not necessarily excellent 5, 10 or 20 years later. (Should I pay for drug coverage?. . . pregnancy coverage?) I would never rely on this book for making policy decisions or for forming opinions on healthcare in the United States. I strongly disagree with many of his policy recommendations.
Some problematic propositions from the book:
1. Several places in the book he claims that insurance companies in the individual market only turn down or place exclusions on 20% of applicants and 80% are accepted as healthy. He uses this statistic to support his thought that most people can get coverage in the individual market. I don’t know about the accuracy of this statistic, but one problem is that people who are uninsurable often do not apply for insurance on the open market. They stay on their employer plot. They go into a risk pool. They buy a conversion plot. Etc. Even Pilzer advises against applying for insurance if you reckon you might get turned down. So the healthy incline to these plans and the unhealthy do not.
Pilzer doesn’t discuss what “healthy” might mean and his discussion of the underwriting process doesn’t describe what are the typical issues that eliminate people from coverage. He does not address the maybe of the healthy fleeing to cheap plans while the unhealthy are trapped in what they already have, causing greater cost disparity.
2. For those who say they can’t afford shape insurance Pilzer claims that “If your annual income is below the federal poverty line, about $20,000 for a family and $10,000 for a single individual-you probably qualify for Medicaid.”
This simply is not right, unless you have children at home, are disabled, or meet some other special category. Low income alone does not qualify a self for Medicaid.
In this same vein, he claims that of the 45 million uninsured, 16 million earn more than $40,000 for a family of four ($20,000 for a single) and 29 million earn less. He assumes that the 29 million earn at least $20,000 if a family and $10,000 if single. Otherwise he claims they would be on Medicaid. He maintains that these low income families could easily buy a low cost HSA plot. But how are they going to pay those huge deductibles? Also, his cost data is for people age 35 and their families. In most states, the older you are the more expensive insurance gets. In this discussion, he ignores the issue of underwriting and possible exclusions for preexisting conditions and ignores the fact that in most states, this population could not afford the risk pool which runs on the average, 200% the cost of the same plot for a healthy individual.
3. “Even with what you read in the newspapers, there are shape insurance optionsavailable for every American, although it may take you some time, try and expense to get them.” This is one of his soundbite quotes he uses in advertising materials for his book. This is misleading. Insurance on the individual market is not available for many people. The risk market policy will have preexisting condition exclusions and may have coverage riders unless you are coming off of a group plot and have HIPAA rights. The risk market may be unaffordable. If you don’t have HIPAA rights, there may be no option for you at all in some states.
4. He states that “the premium you pay for an individual or family policy cannot be raised each year, nor can the policy be canceled based on your shape or your former year healthcare costs.” He mentions this several times in the book. At best this is a case of overgeneralization, at worst it is a misleading statement to support his thesis that individual shape insurance is the solution to our insurance woes.
I have read a lot about shape insurance. Federal law requires guaranteed renewal of individual shape insurance plans. Does this mean that rates cannot change based on your shape status? Many state’s insurance regulators reckon so. But that does not make it law. Most states allow rates to increase based on age. Some states’ laws do provide that your rates can’t go up based on your personal shape situation. But other states have no laws that apply and in general, the individual market is not highly regulated. From what I have read, experts are not in agreement as to the extent re-underwriting occurs on renewal and insurance companies are not very forthcoming with information about why a particular self’s rate increases. Some experts believe that re-underwriting is occurring more and more by a number of insurance companies. Also, some insurers have durational rate settings. This means that your insurance costs can go up considerably after a few years. At that time, you can reapply for a lower cost policy, but can be denied if you are not in excellent shape.
4. Pilzer repeatedly claims that individual shape insurance is cheaper than employer provided insurance. It probably is cheaper if you are 35 and healthy. Probably not if you are 60. This is because employers payment the same rate to everyone, whether you are 20 or 60. Also, only 4% of people in the US have insurance on the individual market. So it is a small part of the overall market. Pilzer doesn’t break down what that market looks like as to age and shape of its participants.
5. Pilzer’s discussion of the uninsurable and state subsidized programs like riskpools leaves much to be desired. Mostly because there is so much state variability. This is another circumstance where I really disliked that he used facts applicable to a 35 year ancient male. The costs are considerably higher for those 50 and over. He fails to mention that some risk pools have low lifetime limits and other restrictions.
6. Pilzer pushes the thought that small employers should go to a reimbursement model, leaving their employees to buy shape insurance on the individual market. Employers with older/sicker employees are in fact facing higher costs. But, their employees are going to have problems getting insurance on the open market and may end up with only very high cost options. The employer that has a young and healthy workforce already has lower costs.
Anonymous
21. Aug, 2009
5.0 out of 5 stars
Please! Read this book BEFORE medical hard/dianoses and if self-employed!!!!
You must read this book – there are so many fantastic tips for attaining your own shape insurance. Do NOT willy-nilly just apply for a policy WITHOUT first reading this book…
Bast
21. Aug, 2009
This book was a terrific summary that will help individuals, families and businesses know many new ways to hegemony shape insurance costs. It is NOT mainstream thinking within the insurance industry. Like bankers, insurance executives tend to be nervous about change, and it may be more hard than Mr. Pilzer asserts to find knowledgable counselors for individuals or businesses who want to apply his suggestions.
My experience with the book was very similar to that of the TPA (Third Have fun Administrator) in TN as I found myself flipping back to various pages to make sure I “got it”. Many times I did this only to find a chart summarizing Pilzer’s response to my question on the next page, so my advise is to read the book twice, the first time only for concepts.
A California resident, I have checked a couple of plans for my family of three and am able to validate Pilzer’s data personally. I was a Fortune 1000-employee for many years before becoming self-employed and I’m particular his assertion that individual plans are less expensive for healthy people is right, even with the conventional wisdom in the group-oriented insurance industry to the contrary. Too many employees covered under group insurance are unaware of how much they and their employer is really spending on shape care.
Overall Pilzer does a very excellent job explaining critical shape care issues. I woud have liked to see even more information on long term care and disability insurance. For me, the most significant chapter was his acknowledgement that there are many incorrect ways for employers to approach a transition away from group insurance.
This book is a sound investment for anyone who pays or might pay any part of their family’s shape insurance, or dare I say bureaucrats with a need of a dose of well-researched reality. It also has some brilliant strategies for those approaching age 65 or seeking early retirement.
Tacey
22. Aug, 2009
5.0 out of 5 stars
Permanent Insurance
Best book on Shape insurance solutions I have ever read and I am an insurance agent who reads a lot. Mr Pilzer has his hands around the problem.
Wallis
22. Aug, 2009
4.0 out of 5 stars
An option of choices
An option of choices and solutions to finding shape coverage. Simple to read and know.
Vivek
22. Aug, 2009
5.0 out of 5 stars
Turned a intricate issue into something understandable
The book did a fantastic job walking through the intricate maze (or land mine) of finding shape insurance.
Kevin
22. Aug, 2009
5.0 out of 5 stars
Must-have for RVers
This book is a must-have for people who are thinking about or plotting to travel full-time in an RV who are not yet eligible for Medicare.
Bayard
22. Aug, 2009
5.0 out of 5 stars
Invaluable help in navigating the shape insurance maze
An brilliant,indeed invaluable book with concrete, thorough information and advice on how to get excellent shape insurance coverage, especially aimed at those not covered or…
Ione
22. Aug, 2009
3.0 out of 5 stars
Not so hot for those with chronic illness
I found the book mostly informative and was excited to get the chapter for those with chronic illness, until I read the first section…
Anonymous
22. Aug, 2009
5.0 out of 5 stars
The must have shape insurance guide
This book fills in all the wholes in the shape insurance market that allows you to make informative decission on the direction for your shape insurance needs for the family and…