Another few words on Open Enrollment

Building on yesterday morning's post, it bears repeating that even though I'm no longer active in the individual market, I still get calls, emails and referrals seeking my assistance. Since I'm loathe to just leave folks hanging, here's a brief recap of what we usually discuss:

First, going bare is not necessarily an irrational decision. When one is facing thousands (often tens of thousands) of dollars in out-of-pocket before a plan kicks in, well, it's difficult not to at least consider this route.

Second, of course, is an ObamaPlan (although these have become increasingly difficult to find, since so many areas have only one or two available). These satisfy the ObamaTax, and cover pre-existing conditions.

Third would be Short Term Medical plans, which don't satisfy the mandate, but offer lower premiums and out-of-pockets.

Fourth would be Health Care Sharing Ministries, which are ACA-compliant, but pose their own challenges.

And finally, there's what I call "Dave's Plan," which is not ACA-compliant, but can offer a valuable bridge at a reasonable price.

And yes, I know: I know, DPC is also an option,but I'm not going there until there's a cat plan available to wrap it.

Did I miss any?

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Oy Canada: CanuckCare© Strikes Again

Previously on CanuckCare©:

"[A] doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection."

And that's if the patient is "fortunate" enough to even get an appointment.

For many, that's quite the luxury:

"I actually thought I misread it’: Doctor ‘stunned’ over years-long wait for specialist appointment"

What the heck's she talking about?

Oh:

The joys of government-run health "care."

But hey: it's free!

[Hat Tip: FoIB Dr Gerard G]

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Back in the (MMO) Saddle Again

As regular readers know, I've basically called a moratorium on new individual health insurance sales. At least part of that is driven by the fact that my immediate service area offers exactly 3 carrier options, none of which I'm interested in representing (let alone selling).

But just a few miles north of here, Medical Mutual of Ohio still maintains a footprint, and I received a call from a young lady who was interested in climbing aboard the MMO bandwagon.

She's currently with Anthem, which is going away at the end of December (so much for that explicit promise). Fortunately for her, MMO offers a plan that fits her needs and budget, and is available off-Exchange (she's not subsidy-eligible, so no reason to venture into that dark cavern). I popped over the the MMO agent portal, ran the quote, and about 15 minutes later had her all signed up.

So why did I agree to write this case?

Well, for one, thing, it killed me to leave this poor lady hanging: she knew enough to avoid the online marketing sharks, and had educated herself on what she really needed. In short, exactly the kind of client I prefer.

So, sometimes the exception makes the rule.

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Workers' Comp and The Mandalay

In the comments section at the link to the most recent Health Wonk Review, IB regular BernieFlatters wrote:

"A little off topic, but I read that some "first responders" during the Las Vegas shooting are being denied workers comp claims. What the article doesn't say from the headline is that these guys were at the concert as attendees, not as law enforcement. So they spring into action, get hurt, fly home, make claims because "never off duty" or something like that, and the rest makes a good example why we are a nation of emotions and not laws."

I found this to be particularly intriguing, so I reached out to FoIB (and Workers' Comp guru) Julie Ferguson for her thoughts, which she graciously agreed to share with us:

That’s pretty interesting, but there are no easy answers there.

Workers comp is for injuries that occur in the course & scope of the job. Every state has a slightly different law, but that is fairly common wording. In a case like this, there is a lot of gray.

They call that issue compensability. Was the injury compensable? With any claim, that is the first thing the insurer does is determine compensability. Did the injury happen at work? Probably 90% or more of the cases, that is clear cut, but there are cases like the ones you describe that end up in court.

The cops who were working, if injured, that is a clear case of workers comp.

The off-duty cops who spring into action? Not so clear.  Most laws are clear that it is “in the course and scope of work” and many edge cases wind up in court.   “Never off duty” is not a very precise phrase when it comes to legalities. It would be  nice to think that an employer would just say “gee, that guy did the right thing, let’s cover him” but you have to be consistent and precise about compensability legalities or you can find yourself in quicksand.  Your insurer, lawyer, taxpayers or board of directors  are not likely to accept sentiment as valid legal basis.

Some of these issues came up in a big way in 9/11.  For example, generally people are not covered by workers comp when they are “going to and fro” – traveling to or from work. You’re on your own health insurance plan if you get hit by a car or fall down. But if you are going to & fro and you fall in the employer’s parking lot, you would be covered. On 9/11, so many people were killed on their way to work or on their way fleeing from work that it got to be a big issue.  Were they on the property or weren’t they? Were they working on weren’t they? It was pretty hard to sort out.

Thanks so much, Julie!

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DisHartening News

(BTW: That's not a typo - wait for it...)

So FoIB The Political Hat reports that:

"More Millennials Are Turning to Witchcraft for Activism & Self-Care"

I replied that since the alternative was ObamaCare, perhaps tha twasn't the poorest choice available.

To which our other good friend, Allison Bell, responded:

"But, really: What do we know about medical witchcraft economics? Maybe there's a lot of inflation in the care to goat ratio."

Which is a fair point, and one that has actually been previously addressed (now):

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Shopping Medicare: The Movie

Co-blogger Bob V is trying something new, and we're pleased as punch to introduce his first video on shopping for Medicare supplements. Pretty timely, too, seeing as how it's Open Enrollment season.

Enjoy!

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More Life Insurance Horribles

That's not how this works:

"Natalie Finn’s parents took out two life insurance policies on their adopted daughter before the 16-year-old died from starvation and abuse in the family's West Des Moines home"

The fiends "parents" had allegedly purchased a $10,000 Hartford Life policy, as well as one from Modern Woodsman for $25,000.

So this poor girl was starved to death for (a measly) $35,000.

Words fail.

[Hat Tip: FoIB Joe K]

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