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Paul Cholak - Principal
Licensed Insurance Agent

877-734-3884   
October 2017 - In This Issue:

We Offer:
  • Individual and Family Health Insurance (Affordable Care Act)
  • Health Plans for Medicare Beneficiaries
  • Life Insurance
  • Pre-Need Funeral Arrangement Plans
  • Final Expense Insurance
  • Life Insurance for Diabetics and Other Hard-to-Insure Individuals
  • Annuities
  • Dental and Vision Care Coverage
  • Supplemental Health Insurance
  • Prescription-Only Drug Plans
  • International Travel Medical Insurance
  • Disability Insurance
  • Short-Term (Recovery) Care Insurance
  • Long-Term Care Insurance
  • Pre-paid Legal and Identity Theft Plans
About our Principal,  
Paul Cholak


Paul holds resident (Florida) and non-resident life, health and annuity licenses in 31 other states and is registered to sell individual and SHOP plans on the Federal Facilitated Marketplace.  He also has a Florida pre-need sales agent license,
 
In addition, he's also appointed to sell Prepaid Legal Expense and Identity Theft Plans.

He has many years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms.

Paul negotiated the first labor contracts that included the concept of "reasonable and customary" reimbursement and also implemented the first group dental insurance plan.  

He knows all aspects of individual and family health insurance and has extensive experience with group plans, as well.

He's available 24/7 and stays in touch with his customers before and after they've made their insurance purchase.  He's always available to help customers who have claims or other problems with their coverage or have any questions about their policies.

He's a recipient of the prestigious Albert Nelson Marquis Lifetime Achievement Award and been listed in Who's Who in America, Who's Who Registry of Business Leaders and Who's Who in Finance and Industry. Early in his career he was identified as one of the Emerging Leaders in America. 

He's a member of Phi Beta Kappa and other national honorary societies and organizations such as Omicron Delta Kappa. He's also an Ambassador with the Boca Raton Chamber of Commerce. He's a graduate of certificate programs from a number of prestigious institutions, been invited to speak at corporate and university training programs, been featured in articles in national books and magazines, and is also a published author.   
 

Latest ACA Repeal Try Derailed
On Friday, September 22 Senator John McCain of Arizona announced his opposition to the Graham-Cassidy bill, which was the latest (and probably last) effort of the Republicans to repeal and replace Obamacare. Senator Rand Paul of Kentucky had already announced his opposition to the bill, and Senator Collins of Maine announced her opposition to the bill last Monday. Other senators were leaning against voting for the bill, as well. Recognizing that they did not have enough votes to pass the legislation, Republican leadership pulled the bill last Tuesday and it will not be voted on.
 
Because the special budget rule that permitted 50 votes (plus the Vice President's vote) to stop filibusters expired September 30, the Republicans will not be able to push through repeal/replace legislation unilaterally unless they receive bipartisan support. Please see this article that points out possible next steps in reforming the Affordable Care Act.
 
I've been predicting ever since the Presidential election that the Republicans would not be able to pass repeal and replace and I have been proven to be correct. The only feasible next step is to pass bi-partisan legislation designed to correct some of Obamacare's flaws that both parties agree need to be fixed.
 
Republican Senator Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington had been working of a package of limited legislative fixes to the health law's marketplaces before Alexander suspended the effort as the Graham-Cassidy bill advanced in the Senate, but it was announced on September 27 that Senator Alexander is attempting to resurrect this approach.
 
In the past few weeks one other initiative failed, as well. Senator Bernie Sanders had introduced legislation that would have established a single-payer system akin to Medicare for the non-Medicare eligible population but this bill failed to garner the necessary support.
 
The Graham-Cassidy bill would have eliminated the mandate for people to carry insurance or face penalties. It would have repealed the financing for Obamacare's health insurance expansion and create a big pot of money states could have tapped into to set up their own programs, with less federal oversight. It would have limited spending for Medicaid, and insurance rules that protect people with pre-existing conditions could have been loosened through state waivers.
 
Over time the legislation would have significantly reduced federal health care dollars now flowing to the states.
 
The bill had broad opposition from governors of both parties, as well as a wide array of medical industries and organizations.
 
This article contains an analysis of what was included in the draft Graham-Cassidy bill.
 
Obamacare Open Enrollment
Florida Blue will be beginning open enrollment for off-exchange members and prospects starting October 4 and ending December 15.

Otherwise, open enrollment for both on- and off-exchange will run from November 1--December 15. ACA open enrollment extended to January 31 last year and a significant number of people enrolled in the last six weeks last year.

There's been some speculation that the Administration may extend open enrollment because of the recent hurricanes, BUT carriers do not expect this to happen. ACA open enrollment will almost mirror open (annual) enrollment for Medicare beneficiaries this year (Medicare annual enrollment runs from October 15--December 7, so agents will have much less time to help people enroll for 2018 plans), and carriers are trying to establish expedited enrollment and re-enrollment procedures because of this time compression.

Preliminary indications are that highly- subsidized individuals who have elected silver level cost share reduction plans (those with the two highest levels of subsidies which are called level 5 and level 6 reductions) will not see significant net premium changes for 2018 at least from Florida Blue and Ambetter.. However, those with level 4 reductions (whose earnings are between 200 and 250% of the federal poverty level) and subsidized individuals who have silver level plans but are not eligible for cost sharing reductions (those whose earnings are between 250% and 400% of the federal poverty level) will see significant increases.

Individuals who bought on-exchange plans (particularly silver level plans) but are not eligible for subsidies will be heavily impacted if they do the same for 2018. Florida Blue will be adding silver plans that can only be purchased off-exchange in an effort to mitigate this situation.

Those with Humana plans or grandfathered Aetna plans will need to purchase 2018 plans from other carriers.

Florida Blue will be offering plans in all 67 Florida counties again this year.

Six different carriers will be offering on-exchange plans in Florida, and all of these carriers will be offering off-exchange plans as well.

Florida Blue, Ambetter (also called Centene or Celtic), and Molina will be the major carriers offering on-exchange plans in South Florida. (There are six carriers offering on-exchange plans somewhere in Florida). Molina's approved rate increase will be almost double that of the other two carriers, so we don't expect them to be a major factor in the market for 2018.

Nearly 75% of Florida Blue's current members rely on subsidies, and Florida Blue will be the major carrier in the market again for 2018. Ambetter's rates will be competitive.

An important consideration when buying an on-exchange plan in particular is network access. The most highly subsidized clients do not tend to consider whether or not their doctors are in network, but doctor availability should be considered when choosing a plan. We continue to hear of cases where buyers do not consider doctor availability when choosing a plan and then find they have to travel long distances or wait a considerable amount of time for appointments; accordingly, we suggest that ALL buyers consider what providers are in-network before they buy they plans.

All six on-exchange carriers will be offering off-exchange coverage and three carriers will only be offering off-exchange coverage. Florida Blue and AvMed will continue to be the major carriers offering off-exchange coverage in South Florida. AvMed's premium increases for off-exchange plans will be significantly higher than those of Florida Blue, so we expect Florida Blue's Blue Options and Blue Select plans to be the predominant plans in South Florida. Most individuals who purchase plans off the exchange purchase non-HMO type plans, whereas HMO-type plans are the only kind of plans offered on the exchanges.

Don't plan on enrolling in an on-exchange plan on November 15 or on Sunday mornings before noon, as the exchange will be down for maintenance at these times, so enrollment will not be possible.

More details about plan offerings will become available in the next few weeks, and we will be communicating with our clients accordingly. .

Because of the compressed time schedule for enrollment, we encourage individuals with Florida Blue off-exchange plans to review their choices in early October and consider enrolling as early as possible in October before Medicare-eligible beneficiaries enroll in plans starting October 15..

According to this article published in the Washington Post , about 35% of U.S. hospitals have instituted "meds-to-beds" or "beds in hand" programs in which prescription drugs are provided directly to patients just before they are discharged from the hospital and sent home.
 
Hospitals can bill only for medications used on the premises, so these drugs must come from outpatient pharmacies that these hospitals are establishing. Patients must pay for these medications according to their plan co pays for outpatient drugs or otherwise make payment for the drugs if they don't have health insurance coverage.
 
Rules published by Medicare in 2012 penalize hospitals if patients are readmitted within 30 days for the same condition, and private insurance carriers have established similar penalties.
 
Hospitals have established transition of care programs that connect patients with post-hospital follow up doctor's office visits as well as provide medications that can be used at home in an effort to reduce readmission rates and accompanying penalties.
 
These programs are having a significant impact on readmission rates and, accordingly, in reducing costs.
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Paul Cholak
 877-734-3884
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