HMO's, What Goes Around Comes Around

Within the past several years, the new buzz word in the group health coverage market and the individual market as well, has become HDHP (High Deductible Health Plan). While this is definitely a legitimate way to market health coverage and develop more cost effective products for consumers, I believe that the carriers have missed another opportunity to achieve the same results without the high out of pocket price tag for consumers.

When the PPO and HMO concepts were first introduced, physician and hospital networks were smaller. This allowed the carriers the ability to negotiate better contracts with these facilities and guarantee them lots of business from their covered members and insureds. Due to demand from some consumers, bad press, and even thrashing from Hollywood movies, the industry moved more toward larger networks and easier access. This is good for some consumers, but not all. The open access, large network concept attracts more utilization and higher priced contracts with providers thus putting great upward pressure on premiums.

Keeping the current trend is recommended, but reintroducing the older models of smaller and more restrictive networks as well as the staff model, is a must. There is too much business being lost without this market, as well as an alternative for the uninsured.

I've been informed by at least one HMO rep to expect this type of market to resurface. I agree.

Any other benefits agents out there, your opinions are appreciated.

Medicare Modernization Act and Group Health

The new Medicare Drug Act of 2003, AKA the Medicare Modernization Act, begins its enrollment period for beneficiaries on Nov 15, 2005. This is the new Medicare Part D.

If you are an agent who works in the Group Marketplace, then this is a great opportunity to hook up with clients. How often do you hear some of your clients say that you only call on them during renewal time? Well, then this is the perfect time to show how interested you are in their well being all season long. The new Medicare law requires employers to notify their employees of their rights if they offer group health benefits. For further details, please view the National Association of Health Underwriters website. www.nahu.org. There is a link to much needed information to help employers in honoring their obligations.

Medicare Part D

As I stated in the first post, Medicare Part D is shortly becoming a reality. Go to the National Association Of Health Underwriters (NAHU) website for more information.
www.nahu.org. Some people think putting in this benefit for medicare was great, some think it was not worth the effort. What is your opinion? Let me know if you don't know what this is all about. We will know pretty soon if this is worthwhile to sell since the coverage will be offered privately and at different costs. The plan can be modified from what the government published in its outline of coverage.

The Changing Market

The marketplace for Senior citizens continues to change. This year new plans and carriers have entered, while others have exited. This fall, the new Part D of Medicare begins the enrollment process. This is the new prescription plan being offered to people eligible for Medicare. Your questions and comments are welcome, as well as your help and advice to our fellow agents. There has been much criticism of this benefit. Please let us know if you understand what it is, and if you have an opinion of whether this will be a worth while offering to your clients. Should you have any other insurance topics of interest to you, please comment.