OPEN ENROLLMENT for 2017 starts November 1st for coverage starting January 1, 2017.
Gulf Assurance has prided ourselves in championing the little guy, aka individuals, entrepreneurs, and very small businesses.  Unfortunately, the very high cost of individual coverage in Texas has led the major carriers, Aetna, BCBS, Cigna, Humana, and United Healthcare/Golden Rule to decide the service of independent agents is a cost to be cut.  Therefore, since a 0% commission can't keep the lights on, we can no longer offer our services to the individual market at no cost.  If you need an individual plan, you can to contact www.Healthcare.gov to get a Navigator to assist you at no additional cost. However, if you prefer to have me serve you this year, I will have a reasonable agent's fee to cover my costs.

I will continue to assist our small group clients throughout the open enrollment season without change or interruption.  

As the Federal Government has had a change in direction, we can only hope the promises to fix the individual health market will be swift, provide the coverage that families need without breaking the bank if they use their insurance plan.  I will be staying on top of legislation and how it affects you.  As soon as options are available, regular clients will be contacted.  As always, your referrals are greatly appreciated and the backbone of my business! 

For the 2017 Open Enrollment period, I am offering a tutorial to assist in the selection of the best insurance product for you and your family. It is based on the analysis I've offered in years past and how to evaluate your options. It is a guide for you but is not a recommendation or guarantee of coverages.

We appreciate your support and loyalty. Have a happy holiday season! 
Our Services
These are the different types of insurance we can provide
  1. Short Term Medical
    A more affordable way to protect from injury or illness but does not cover wellness. Fully underwritten. NOT PPACA compliant. Can be issued up to 11 months.
  2. Small Group Benefits
    Medical, dental, vision and other supplemental policies to help build a benefit plan and retain top talent. Group sizes for Medical start at 2 employees. Other policies between 3-10 employee minimums, depending on the product.
  3. Travel / Vacation Insurance
    Not only covering medical needs, but also lost luggage, interpreters, emergency trip cancellation protection or emergency return protection. An easy way to add peace of mind during a vacation abroad.
  4. Legal Plans - Identity Protection
    LegalShield plans provide protection in case you need an attorney. Annual will updates, contract review, traffic violations and more for a low monthly fee. ID Shield monitors for privacy and ID Theft. Provides breach notification and restoration.
  5. Discount Prescriptions
    Discounts accepted at 80% of Pharmacies. Drug look up feature helps you price meds BEFORE you fill your prescription. Can be used with or without a Major Medical Plan. Also Discount Diabetes testing supplies.
  6. Individual Dental
    Dental plans to help keep you smiling. Some plans have no waiting periods! For preventative cleanings, basic or major dental work, a dental policy helps cover the first thing people see...your smile!
  7. Individual Vision Plans
    Your eye exam can be an early warning signal for heart and diabetic health, not just ensuring you can see well. An annual exam can catch early indicators besides providing eyeglasses or contacts.
  8. Key Person Insurance
    A type of insurance to protect your business when a key person is the glue to your business. It provides a safety net for the business to stay open and afloat in the case of death of a key contributor.
  9. Life Insurance
    A financial tool to protect your family in case of premature death. Often used to cover funeral expenses, college funding, pay off mortgage, and/or provide temporary income for a remaining spouse or your child's guardian.
Schedule for the opening events
  1. TUE 11/1/16
    The Marketplace is open! Renew or apply for individual/family insurance at www.healthcare.gov. Apply before 12/15 to have the policy start on January 1. 2017.
  2. THU 12/15/16
    There is still time to apply for health insurance through the Marketplace. Apply before 01/15/2017 to have your insurance start on February 1. 2017
  3. TUE 1/31/2017
    MIDNIGHT. Deadline to get a individual / family health care plan without a special enrollment period. Plans purchased between 1/15 and 1/31 will have a March 1, 2017 starting date.
Tips for selecting A PPACA Plan for 2017
Get the Best Investment for Your Healthcare Dollars
(This section is best viewed on a PC or Laptop)
  1. Since the carriers decided to cut out payment to agents, you need to be able to select a Healthcare plan for yourself this year. This training is designed to assist you in making good decisions based on your needs for healthcare and protect your bottom line. This information is not a recommendation nor a guarantee of coverage, simply a guideline. Let’s look at options for a plan for Jane Doe. She is recently off her parent’s plan, is looking for coverage to start January 1st, and is enrolling during the open enrollment period. She is in good health, has a steady job in the healthcare field, and expects to make $32,000 next year. Based on her age and income, she will not be eligible for a tax subsidy, but she is eligible for the saver plans until age 30, if she so chooses. She is rarely ill, so she does not go to the doctor very often. She could take or leave the Primary Care Physician, or PCP, copays. Let’s look at some options for her. In this example, we find Blue Cross Blue Shield has HMO plans whereas Aetna and United Health Care offer EPOs. So, what’s the difference? An HMO is a Health Maintenance Organization. A single physician is tasked to be the gatekeeper for the medical plan. To see any other doctor (for non-emergency care), you must first see your PCP and get a written or electronic referral to the doctor of HIS/HER choice. (You rarely have any input into who is referred without a good relationship with your doctor.) There is no coverage for non-emergency out-of-network providers. However, in the case of an actual emergency, go to the closest Emergency Room. Once stable, however, the patient may be relocated to an in-network facility. An EPO is like a PPO, but with no out-of-network coverage for non-emergency care. A PPO is a Preferred Physician Organization. You can select any doctor, but if the doctor is in-network you pay a lower amount. An EPO, on the other hand, is an Exclusive Physician Organization. So you typically have access to any physician you’d like PROVIDED they are in network. Again, there is no coverage for non-emergency out-of-network providers. One plan in our example is an HSA/EPO through Aetna. This is a high deductible plan with no frills. However, this plan allows the client to save pre-tax money into a Health Savings Account for the use of paying the deductible or excluded medical needs. By saving in a HSA, the client can use tax-advantaged dollars to pay for or save for that “to-whom-it-may-concern” catastrophic need, like cancer, a stroke, a heart attack, or even a major fall. So, what else is different between the plans? Perhaps if she were to take some medication every day, she’d want prescription coverage. The first plan is the only one with any prescription assistance. Four plans offer at least some copays for sickness visits. Two offer copays, deductible waived, for using an urgent care center. (Please inform your clients to only use the ER for life-threatening emergencies—the cost for an ER visit stars at $2,000 and climbs quickly!) Please notice in our example all these plans have an out of pocket maximum of $6,850 except the HSA plan which is at $6,450. If she has a major-medical event, her out of pocket costs alone are 20-22% of her annual income. Now we know what the plans include, but Jane wants the bottom line: what is this going to cost? What this training will show you is that the monthly cost is not the only one you need to consider. There is also the cost of insurance, so sick or well, that is a sunk cost, right? So, best case scenario, Jane pays the cost of insurance for the year to receive a wellness visit, wellness labs, and cancer screening as well as any other CDC recommended wellness checks. But what is the worst-case scenario? Isn’t that what Jane wants to protect? That is the cost of insurance (the sunk cost) PLUS the out of pocket maximum! All the other costs of the plan roll into the Out of Pocket Max, including the deductible. The out of pocket maximum number provides the risk exposure. If you were to plot these five plans with the cost of annual insurance (best case), the combined cost of insurance and the out of pocket maximum (worst case) AND the monthly premium, where all three numbers are the lowest is the best return on the investment. In this case, the best plan Is the BCBS Security HMO 100 plan. Using this same analysis, what if Jane just hates HMOs and would rather pay a little more to have more freedom of doctors. Which plan would be second? [Click for animation] The United Healthcare Select Saver. Once you recognize the return on investment and usage of the product, this becomes an easy exercise. So, when could there be an exception to this analysis? Perhaps when someone is a heavy consumer of health care benefits? You may need to compare the costs of using the plan in addition to the savings of the analysis. Let’s do that. Let’s look at John Doe. He expects to have heart surgery next year. John is a 49-year-old master mechanic. He is a smoker, lives in the 77450-zip code, which is in Fort Bend County. He anticipates his next year’s income to be $92,000, and since he is unmarried with no dependents, he will not qualify for a tax subsidy. However, he has had some chest pain and went to see his doctor. His doctor referred him to a cardiologist, who informed him he needs a heart bypass as soon as possible. John has no insurance now, so he needs to select the best plan he doesn’t go bankrupt with the impending surgery. Here are five plans like what we looked at for Jane. But John heard that the Silver and Gold plans are much better and wants to see how those plans stack up as well. At first glance, you see the bronze plans have a deductible hoovering around $6,000 dollars, the silver is half that, and the gold…well there is no deductible there. That’s awesome, right? But pay attention to the out of pocket maximums… Now John knows, for a fact, he will need to see his primary doctor at least one time before surgery, and his cardiologist. He also knows he will spend 3 days in the hospital, have a surgery team, and three follow-up visits with the cardiologist in the six weeks following the surgery. Despite his diagnosis, he’s not taken any prescriptions for his heart. But he sure could have used a short-term disability plan, right? Different topic… Now we come to John’s bottom line. What’s this going to cost him? He looks at the monthly premiums and figures the Gold plan is affordable. With no deductible, that plan looks good to him. But did he make the BEST choice? Calculate the Best-Case Scenario. Then the Worst-Case Scenario. Now which plan might be a better investment? Now let’s look at John’s expected costs for his heart surgery next year. According to an American Heart Association report [1], the average hospital charge for all common heart surgery and procedures -- not including doctor fee -- is $62,509. Per the report, plaque removal from an artery costs an average of $30,588, heart bypass costs an average of $117,094 and heart valve replacement cost an average of $164,238. Staggering numbers, but let’s compare the costs for his bypass. Let’s assume the primary doctor charges $100 per visit unless a copay is used. The Cardiologist, a specialist, is $150 for a visit, except for copays. Assume all medications were covered in the hospital bill and that the care is all in-network. For the sake of this example, we will not have any extra negotiated rate discounts or other odd claims strategies. At least for this example, we compare the plans apples to apples. Which plan is the most beneficial for John’s invested money? The BCBS Blue Advantage Bronze HMO 006. Not only will this plan provide the best coverage for the cost of insurance, it is HSA eligible so John can set aside 3,350 pre-taxed dollars to help defer the costs of his medical needs. For this year, John is in the 28% tax bracket, so he can save $938 in taxes if he saves the entire amount (2). Including his tax savings, the cost of his care is now only $9,898. Do you think John is happy he double checked his math? Sources: http://circ.ahajournals.org/content/123/4/e18.full.pdf http://www.efile.com/tax-service/tax-calculator/tax-brackets/ So, if you are expecting a major event, the plan cost per month is NOT the most important risk factor. The Worst-Case Scenario is! The gold plan, with no deductible, makes people feel like they are getting better coverage, but because of the extra premium AND the high out-of-pocket maximum, it would cost John MORE money. Now that you can see WHY this analysis works, how do you do this for the plans you are looking at? The premium times 12 months equals the Best-Case Scenario. The Best-Case Scenario plus the out-of-pocket maximum equals the Worst-Case Scenario. Healthy individuals, with a low risk of medical usage, Best Case Scenario is your tool. BUT remember the risk of the Worst-Case Scenario. Perhaps you can add a low-cost accident or critical illness supplement policy to cover the Worst-Case Scenario risk without adding much premium. And that is something I can still help you with! People with high medical costs, on the other hand, need to be aware of and careful of the risk of the Worst-Case Scenario. If they can pass underwriting requirements, adding a critical illness supplement may also help increase coverage at a lower cost. Source: Agency for Healthcare Research and Quality. Total Health Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2012. Medical Expenditure Panel Survey Household Component Data. Generated interactively. (October 22, 2015) As everyone gets concerned about these out of control costs, here is a little bit of statistics to just to keep in mind. The Center for Financing is responsible for researching the Access and Cost Trends of Healthcare through the Agency for Healthcare Research and Quality. They produce an annual report called the Medical Expenditure Panel Survey, the most recent data available being 2012, and per that report, the median amount spent on medical bills for the year per person was $1302 in 2012. The average amount spent was $5036. Per the government’s own data, seen here, an individual has LESS than 2.6% chance of spending more than $5000 for the year. Additionally, an individual has less than 1% chance of spending more than $1300 for the year. That is a fairly low risk for the typical individual so why spend a sunk cost that cannot be recovered? Some of you may want to know what IS the median? Only 82% of the survey respondents had ANY medical expenses, so line up all the responses of the 82 percent, in numerical order, and select the number in the center of the list. THAT number, in the middle, is the MEDIAN. Source: Agency for Healthcare Research and Quality. Total Health Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2012-1997. Medical Expenditure Panel Survey Household Component Data. Generated interactively. (October 22, 2015) Of the 82% that had medical expenses, how were those medical expenses paid? According to the distribution, 14.7% were out-of-pocket costs, 55.5% were paid with private insurance, 8.9% were paid with Medicare, 11.1% were paid by Medicaid, and 9.9% were paid with other forms of payment. This final chart shows the impact of the uninsured rate for the first year of the Affordable Care Act along with the past 12 years of uninsured data. The impact of the Affordable Care Act has been minimal but the COST has been very high. Typically increasing between 11-300% per year since the law was passed. I hope this information will help you select your health insurance as you would any other investment. Education is key. For further questions or permission to reuse this presentation, please contact Sheri Sanderson at sheri.sanderson@gulfassurance.com or (281) 830-2213. ©2015-2016 Sources: Agency for Healthcare Research and Quality. Total Health Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2012-1997. Medical Expenditure Panel Survey Household Component Data. Generated interactively. (October 22, 2015) KCMU Analysis of 2001-2014 National Health Interview Surveys, cited from http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ (November 20, 2015) Early release of selected estimates based on data from the 2014 National Health Interview Survey, tables 1.1b, 1.2a-b cited from http://www.cdc.gov/nchs/fastats/health-insurance.htm (November 20, 2015)
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