2016 Open Enrollment – Healthcare Reform

You heard right, premiums are increasing and you have less of a choice in insurance companies effective 01/01/2017.

As of this year’s Annual Enrollment Period (AEP) beginning November 1st, if you do not have Major Medical Insurance and do not qualify for Subsidy (government assistance to pay premium), you will be very limited on the choices you have for a Qualified Health Plan on the open market.  For the counties of Hardin, Jefferson and Orange in Texas, the only option an Individual or Family will have available to them for a Fully Insured Qualified Health Plan will be through BlueCross BlueShield.  All of the plans through BCBS will be HMO plans and have had on average in these areas a 48% price increase.

For individuals and families that qualify for Subsidies (government assistance); the following companies will be available:

  • Hardin County – BCBS, Christus Health Plans
  • Jefferson County – BCBS, Christus Health Plans, Community Health Plan and Molina
  • Orange County – BCBS, Community Health Plan

Should you want to know who is participating in your county, please contact us directly for a quote.

With BCBS being the dominating insurance company for Individuals and Families, they have made modifications to their plans, and are offering a new plan this year. The HMO Network has grown tremendously throughout the state.  There are now 50% of the PPO Doctors contracted in the HMO Network and 60+% of the PPO Hospitals in the HMO Network.  Please keep in mind it is always important to check your physician’s network status regularly to see if he/she is in or out of network.

MD Anderson, as of today’s date, has not changed their position and will remain “Out-of-Network” for anyone on a Individual Health Insurance plan.

For the BCBS 2017 plan year, CVS Pharmacy will not be considered “In-Network”; however, you will have access to pharmacies like Walgreens, Walmart, Sams and HEB.

We try to keep our policy holders up to date with information as we get it.  We do verify all information we receive to make certain it is the most accurate and up to date information available.  Should any of this information changes we will notify our policy holders immediately.

The tax penalty for not having insurance in 2017 will be: 2.5 percent of your annual household income above the tax filing threshold to a cap of the national average bronze plan premium.$695 per adult and $347.50 per child under 18 to a maximum penalty of $2,085 per family.

If you would like to receive a quote for Medical Insurance, please contact our office at (409) 227-4686 or you may complete a form online by visiting our website at http://www.martinandmartininsurance.net.  We look forward to hearing from you all!


Rising above the Rising Waters

August 12, 2016, homes in Southern Louisiana were beginning to flood from a torrential downfall of rain that occurred over the course of a couple of hours.  Many homes began getting water coming in that afternoon/evening.  However, some homes did not notice they were going to flood until the early morning hours of August 13th.

A local resident in Denham Springs, LA; lived in an apartment on the first floor.  She went to bed on the night of August 12th, thinking they would be safe from the flood.  Much to her surprise she and her husband awoke to water coming in their apartment.  She posted on her social media outlet at 6:46am; “It’s rising so fast. Power is out. I’m so scared. Waiting on help. Can’t get out. Car and truck are under water. We didn’t think we’d flood. We should’ve left last night…”

first signs of water entering

Between the hours of 5:45am and 10:30am the water in their apartment rose to 4.5′.  They had to be rescued and leave all their belongings behind, grabbing what they could on the way out.  Outside the apartment, in some areas, the water was above shoulder deep.

The top picture is their French Doors to their apartment and shows where the water was when they left.  The white truck is theirs, along with the Camry parked with water up to the windshield.  The photo credit of Denham Springs goes to Oliver Lutro.

Upon asking about Flood Insurance, they were told they were not “in a flood zone” and that the Flood Insurance would not be needed.  They were not presented with an estimate for this insurance and took the advice they were given, as like many others in the area.  Since they were living in an apartment the only coverage they would have needed was for their Contents on both a Tenant’s Policy and a Flood Policy in order to be protected.  Due to not having this coverage this couple had to watch their hard-earned valuables, literally be washed away in the floods.  This picture below shows the final rising of the damage to the outside of the apartment complex.


Now, to put things in perspective; a Flood Insurance policy on strictly contents in a “X” flood zone like theirs is an average of $300 or less for $50,000 in coverage for a year.  Now most people don’t need $50,000 in coverage but this shows how inexpensive this coverage is.  Now in hindsight, sure this couple wishes they would have been presented with this option.  However, in most cases decision makers in families tend to not elect Flood coverage if they are not in a designated “flood zone”.  They see it as an expense they cannot afford at the time and would rather just “take the risk” of not having the coverage.

The pictures above show the interior damage to the apartment.  You can see where the water rose to and the mud that is now layering the carpet.  In the first picture you can see where the water was even able to pull the refrigerator away from the wall and cause it to fall over.  This was total devastation and a loss this couple was not financially, mentally or emotionally equipped to handle.

FEMA Assistance

As you can see from the above FEMA Disaster Assistance program, you are able to get financial assistance to recover from your loss; HOWEVER, notice first sentence under the section labeled Loan Terms.  Disaster survivors MUST repay SBA Disaster loans.  So now,  you are repaying the government for a loan AND you’re paying interest.  You might even at this point now be paying for Flood Insurance on top of this because of the lesson you learned by not being covered.

In this example, this flood victim has lost between $10-$15,000 in valuables inside their apartment.  Some of these are replaceable; however, some are not.  Since they were in a “X” flood zone, they could have paid an estimated $225 or less per year for $25,000 in contents coverage.  In 5 years they would have paid an estimated $1,125 to be financially secure during a natural disaster such as a flood.  Now in this couple’s case they were not allowed to make an educated decision on a Flood policy and whether or not they should purchase a policy.  However, many flood victims might have made the decision to “roll the dice” and not purchase the flood insurance, because they are in a non-flood zone.

Per National Flood Insurance Program; “Flooding can occur in moderate- to low-risk areas as well as in high-risk areas. Poor drainage systems, rapid accumulation of rainfall, snow-melt, and broken water mains can all result in flood. Properties on a hillside can be damaged by mud-flow, a covered peril under the Standard Flood Insurance Policy. In high-risk areas, there is at least a 1 in 4 chance of flooding during a 30-year mortgage. For these reasons, flood insurance is required by law for buildings in high-risk flood areas as a condition of receiving a mortgage from a federally regulated or insured lender.”

With this being said, anyone could be in a flood zone if the conditions are right for it.

This lovely couple is still struggling 2 weeks later to find a place to live, as they have pets and availability is very limited.  They are looking to move to another city which will be closer to her husband’s work or even back to Texas where they are from.  In the meantime, they are living in a hotel with what memories they have left and their fur-babies.  They are a very positive and uplifting couple in the midst of their devastation.  When I asked her what would she advise others now that she has experienced this loss…

“Trust God.  He will get you through even when you don’t know how.  And BUY FLOOD INSURANCE NO MATTER WHAT!!  Most that flooded weren’t in a flood zone and you see what happened”

I write this blog to bring awareness to others and show what happened in Southern Louisiana could happen anywhere.  Floods usually strike without warning. They’re always swift and severe. The threat often comes from events like hurricanes or heavy storms, but they can also occur after a drought or wildfire, when vegetation that would normally absorb excess water is no longer there. So it’s important to be prepared.

5 Reasons Flood Protection can’t wait:

  1. Every home is at risk, with floods and flash floods recorded in all 50 states regardless of terrain or climate.
  2. Almost 25 percent of all flood insurance claims come from areas designated as “minimal flood risk.”
  3. Flood damage is not covered under most homeowner insurance policies.
  4. Federal disaster assistance often comes in the form of a loan with interest, and it’s only available if the President formally declares a disaster.
  5. Even after flood insurance is purchased, there may be a 30-day waiting period before coverage begins.

It only takes an inch of water to cause costly damage to a home. Isn’t that worth a measure of protection?

The below picture is all the Louisiana couple has left of their belongings:

All thats left

Run up the Score, Leave No Doubt

In the Disney movie “Remember the Titans”, Coach Bill Yoast made this statement during a game to his players when adversity was overtaking his team.  He knew he had to make the toughest decision in that very moment to side with his players and show them support for combining a mixture of high school kids who were taught they were not supposed to play together.  This did not go well with all the community leaders, but he knew deep down he had to make the change and lead by example.  Coach Yoast changed the conversation that night from what they shouldn’t be doing to how can other teams join together and become just as successful.  What would it look like if we applied this concept to our business models?  The mentality of running up the score and leaving no doubt on our capability to support our clients and rise above any setbacks.

If you are a home builder, for example.  You are responsible for building someone’s dream home, that’s a lot of pressure.  During the process you must be up to date with all building codes, be able to communicate with your sub-contractors accurately and be able to assure the future homeowners that they are getting exactly what they dreamed of or as close to it as they can afford.  In the process of building your first home, everyone in the community is in love with your work which leads you to getting a few calls to build other homes for new future homeowners.  You continue to put your passion into these building projects and somewhere along the way you get content.  Your homes start looking identical.  You have found yourself in a business rut.  Sure you moved a bedroom here and added a column there, but they start to look all the same.  You start to ask yourself questions like “How do I make myself stand out”, “What can I do to set myself apart from my competition”?  You even can start doubting your talents.

So what is the key to “Running up the score and leaving no doubt”?  In my insurance agency it’s about our passion for helping others.  I absolutely love watching businesses grow and become profitable.  Seeing a mom and pop store turn into a Household name.

As an insurance agent, I view myself more of a encourager and advisor.  If I find myself in a situation where I don’t know the answer, I will instantly get off the phone and find it out.  In researching each person/business insurance needs is a process, it takes time and patience.  It’s also about getting to know each customer personally.  Building a relationship that is open and honest.

But isn’t that what all insurance agents do?

The answer is “yes”.  We all do the research, we all smile and we all go above and beyond to make sure you are comfortable with your purchase.  For me, where the difference is, comes when we are not trying to sell you a policy.  Do we still go above and beyond to help you?  That’s where running up the score comes from.  You keep constant contact with your clients no matter the size of your business to “leave no doubt” that we as your insurance agent cares about your business, your family and your investments.

Turning back to the home builder, what would you think if he/she came by a year after your purchase and asked if you were still happy with the home.  What changes you wish you could make?  No, he/she can’t make those changes now, but imagine what he/she could learn from it.

Colossians 3:23 NIV – Whatever you do, work at it with all your heart, as working for the Lord, not for human masters, since you know that you will receive an inheritance from the Lord as a reward.  It is the Lord Christ you are serving.


What sets us apart from others

Many times I am asked “What sets my agency apart from others”.  Over the past 5 years I have truly struggled with what honestly sets me apart from the other Agents out there that offer the same things I do.  We all offer “free” quotes.  Well, lets be honest, who charges an individual for a quote?  Would you pay for a quote?  That’s just a silly thing we as salesmen/woman have been trained to say.

We all have to conform to the same Texas Department of Insurance Regulations, and Federal Guidelines; so nothing special there.  Sure you have the few agents out there that will tell you “oh, that agent isn’t following guidelines” or “that policy doesn’t meet the state qualifications”.  We are all mandated by the same law, so we are all held to the same rules.  If you feel you are being sold a policy that is not meeting state/federal guidelines, you should always get a “second” opinion.  We do this for our medical decisions, why not do this for our insurance needs?  There are also tools online for you to see how the insurance company is rated, like AM Best.  You should always research your insurance companies in the same way you research your physicians.

One day during my lunch break, I saw advertised “Same Day Auto Coverage for $29.99”.   My instant thought was do people really fall for that?  Many companies across the state offer same day coverage and we can all get your premium down very low; but at what cost?  By lowering your premium this much and you actually qualifying for this coverage you have to really give up some things.  By paying $29.99 per month you are basically covering your auto at the state minimums and typically you are not covered for uninsured/underinsured motorists coverage.  This is a big deal and as your agent, it is our job to make sure you understand the coverages you are and are not purchasing.

So, again the question is “What sets apart my agency from the others”?  I feel it comes down to the Agency Service you receive.  When you call your agents office do you feel your agent is going above and beyond to meet your needs and assist you with your problems?  Sure you can pay $64 per month for your coverage, over paying $76 per month; but what service do you receive?  Do you have to call a toll free number to get questions answered or can you text your agent and get a response?  Do you have to conform to their office hours or can you call when you get off work and get an answer from your agent?  Or, do you have to wait on hold and get someone on the other end of the line that does not know you?  So I propose the following question in exchange…. “What is your time worth?”

We all put price tags on our hourly wage when we are working for our employer.  We claim its our “self-worth”.  Why not put a price tag on the hours you spend getting issues resolved with your insurance company or even on the hours you spend shopping for insurance?  What if it was as simple as texting/emailing your agent with your questions or concerns?  A simple text/email could take all of a maximum of 5 minutes (depending on how slow/fast you type emails/texts).  You then get a response within a reasonable time from your Agent/Broker.  The key to this is set expectations with your Agent/Broker, be direct (not rude) in your email/text stating what you need and when you need a response by.  This allows the Agent/Broker to prioritize your request along side the other requests he/she is receiving.

Does this mean you shouldn’t call  your Agent, absolutely NOT.  Your agent welcomes your call and looks forward to visiting with you.  As agents/brokers, we enjoy hearing about your kids, pets and just your life in general!  We also enjoy you to come by and drink coffee with us!  This is how we get to know you and know what you need in order to service you accurately.  Technology isn’t made for everyone; so what if you could stop by and your Agent show you how to have easy access to your policy on your phone or smart device?  These are valuable assets to make not only your Agent work for you but also your policy!

What sets my agency apart from others, reality is there is only one thing that sets any agency apart from another, SERVICE.

“The best way to find yourself is to lose yourself in the service of others”. – Mahatma Gandhi

The truth behind Insurance Companies and your Credit Score

Many times as insurance agents we get asked the famous question; “Why do you need my social security number to provide me with a quote?”  

The reasoning behind this is that insurance agents and companies who you are seeking insurance quotes from will base those quotes on several factors, including your credit score. When we pull up your credit report to find your credit score, it results in an “inquiry” on your credit.  

Insurance inquiries are shown only on your personal credit report. They are not provided to lenders, so they are not considered in credit score calculations or lending decisions. The inquiries are treated the same way as inquiries for employment purposes, pre-approved credit offers, and requests from you for a personal credit report.

When it comes to credit checks, there are two types of inquiries: “hard pulls” and “soft pulls.” A hard pull refers to credit inquiries for acquiring credit; for instance: credit card company or a lender. A soft pull is an inquiry that will review your credit score, much like an agent would to determine an insurance quote.

When we see a potential client with a high credit score most likely we will consider you a low-risk client, someone who pays their bills on time and in full and is responsible. The insurance companies will then be able to offer you more affordable insurance quotes. Good credit saves you money in many different arenas of your life, including insurance.

You may always request the credit check from the Insurance Company/Agent upon rating.

Information gathered from Experian.

What is Medical Payments or PIP Coverage on my Auto Policy?

Ever look at your Auto Policy and wonder what is this?  Well, you are amongst many other insureds who really are confused on what this coverage is and how it benefits you.

Medical Payments Coverage can assist in covering medical expenses or funeral expenses of covered drivers and passengers after an accident regardless of fault.  In most states this is an option available to add to your insurance policy.

In addition to funeral expenses; a few scenarios where medical payments coverage may kick in to help:

  • passengers are hurt while you or another covered member is driving
  • you are the passenger in another person’s vehicle and get hurt
  • should you as the covered person get struck by a car while walking/cycling
  • dental care after an accident
  • extended nursing service or hospitalization while rehabilitating
  • prosthetic limbs

Now by having PIP or Personal Injury Protection coverage, this can assist with the same things covered by Medical Payments; however, it can extend to wage compensation for any missed work due to an accident.  PIP limits are generally higher than Medical Payments, but just because you have PIP coverage doesn’t mean you can’t have the Medical Payments coverage as well.  By having both, should you exceed your limits on PIP after an incident, the medical payments coverage can fill in the gap between your PIP limits and actual medical fees up to the limits of your medical payments coverage.

Whats important to consider while you are building your car insurance policy is your current Health Insurance plan.  If you don’t have a health insurance plan, you would definitely want to add these coverages to your auto policy in the event of an accident you would have protection financially.  Should you have a good, reliable health plan, you might not need PIP or Medical Payments.  Always check the specifics of your health plan or work closely with your agent in order to determine if these benefits would assist you or not.

There are some states that do REQUIRE either Medical Payments or PIP coverage on your auto policy.  Ask your agent if this applies to you or not.

Always remember your best way of finding what coverages are right for you, is by talking closely with your agent and building a relationship with he/she as your needs do change regularly!

What’s to come…Healthcare Reform 2013

With the re-election of President Barack Obama, Healthcare Reform is now on full steam ahead with timelines and new regulations to come.  In order to keep all of our clients up to date with the most accurate deadlines, Martin and Martin Insurance will be communicating come each date the new regulations.  In this first communication, we are going to cover the entire year of 2013.  Please note these could change and that there could be additions as Congress approves new regulations.

ü  Effective 01/01/2013 medicare withholding tax will increase from 1.45% to 2.35%

  • Applies to employment income in excess of $250,000 if married or $200,000 if single.
  • Medicare tax on self-employment income will increase from 2.9% to 3.8%
  • 3.8% medicare tax imposed on net investment income for taxpayers with modified adjusted gross income over $250,000 if married or $200,000 if single.

ü  Effective 01/01/2013, Health FSAs are limited to $2,500 (subject to annual indexing for inflation)

  • Limit applies only to employee salary deferrals and not to employer non-elective FSA contributions.
  • An employee covered under a qualified HDHP with an HAS can use the HAS for qualified medical expenses; see definition under IRC 213.
  • IRS has said cafeteria plan documents do not have to be amended immediately, but just before the end of the 2014 calendar year.

ü  On 01/01/2013, HHS will evaluate each state’s progress in establishing its health insurance exchange.  If progress is deemed insufficient, HHS can step in to establish and run the states exchange effective 01/01/2014.

  • The exchange applies to the individual and small group markets (<100 employees) initially; employers > 100 employees can join exchange in 2017.
  • Its too early to know which carriers will participate in each state’s exchange with plans will be offered and how much exchange based coverage will cost.

ü  For W-2s to be issued in January 2013 (i.e. 2012 Tax year), employers issuing more than 250 W-2s will be required to report the aggregate cost of employer-sponsored health care coverage on their employee’s W-2s.

  • This does not mean the value of health coverage will become taxable income
  • Does not apply to Health FSAs if contributions only occur through salary reduction
  • Does not include Dental and/or Vision coverage that is considered limited scope or unbundled from Medical/Rx benefits
  • Does not include costs under an EAP, wellness program or on-site medical clinic if the employer does not charge a premium for that coverage under COBRA.

ü  On 03/01/2013, employers will need to provide their employees notice about the future availability of a health insurance exchange in their state.

ü  By 7/31/2013, insured and self-funded plans will pay $1/member to fund comparative effectiveness research of medical treatments by the new non-profit Patient Centered Outcomes Research Institute.

  • This requirement took effect 01/01/2012 for calendar year plans
  • Employers will use revised IRS Form 720 to remit the fees
  • Fees for plan years beginning in 01/01/2013 will be $2/member

ü  By 12/31/2013, group health plans must certify they are in compliance with HHS rules on electronic transactions between health providers and health plans.


Open Enrollment Time

Yes, its that time of year again!!  Many of you are receiving your packets from your employers about your Employee Benefits.  And just like many other Americans, you might be shocked to see changes this year in your plans and pricing!  With new regulations now in place due to Healthcare Reform, as well as the ever-rising increase in health care costs, you as an employee will need all the help you can get.

Employers are making some of the toughest decisions ever this year in regards to benefits and prices.  Due to this employees need to take extra precautions to make sure to review their benefits to make the right choice on coverage for the price they can afford.  The first step at doing this is making sure to review the Summaries of Benefits for the plans provided.  If you are not handed this or mailed, some companies are making this available online and you could even access it through the insurance companies website or mobile app.  You may request/view this Summary of Benefit at any point throughout the plan year.  Make sure to add it to your favorites list!  Remember, if you have any questions about any of the coverages while reviewing this prior to making a decision, write them down, then visit with you plan administrator about your concerns.

While reviewing your Summary of Benefits have a calculator handy and visit with your significant other to discuss all the aspects of the plan.  Project your total cost of the plan options over the year.  Discuss how many trips to the doctor over the year you might make, (remember your preventative care is covered at 100%).  Are there any surgeries, births or medical concerns that might persuade you to go with a lower or higher deductible?  What is your current prescription intake?  Do you need copays on prescriptions?  All these questions could impact your decision on the plan you decide to enroll in. 

Also, make sure to check to see if your company is offering any savings accounts to your medical plan to take advantage of.  Some of these types of accounts are HSA’s (health savings accounts), FSA’s (flexible spending accounts) or HRA’s (health reimbursement accounts).  These accounts are typically set up with your employer contributing some dollar amount to the account and you being able to make additional contributions on a “pre-tax” basis.  These savings accounts can be used for any type of Medical, Dental, Vision or Pharmaceutical benefit.  There are limits as to how much can be contributed into each account, so please make sure to visit with your plan administrator.

Wellness is another benefit to look for.  See if your employer or insurance company is offering any type of wellness incentive for you and your family.  The incentives could be in the form of insurance premium discounts, gym memberships or even prizes!

Don’t forget, open enrollment isn’t just for your Health Insurance!  Review all your documents!  See if your company is offering Dental, Vision, Life, Disability, or even a Supplemental policy that will pay you, not your doctors.  

Last but not least, don’t forget your deadlines!!  It is very important to turn in all paperwork timely.  If you miss your one opportunity to sign up, it could end up costing you more by having to pay higher healthcare costs.  Open enrollment is once a year, any changes or elections must be made during this time; otherwise, you will not have another opportunity until another year from now without a Qualifying Event.


Snapshot with Progressive

Upon mentioning this device to clients, I get the remarks “I don’t want an insurance company invading my privacy” or “I don’t want the insurance company tracking me”.  This is not the case with this Snapshot from Progressive.

Snapshot is a plug in device that fits right under your steering column.  Through the device there is no way Progressive can track your whereabouts or invade your privacy.  This device is monitoring your “Hard Breaking”, not your speed or whether or not you are using your turn signals accurately.  The device is also monitoring how many miles you drive and if you drive during the hours of midnight and 4:00 a.m.  

The program is very easy and you can even monitor the progress of your driving and discounts online!  You simply contact your Progressive Agent and tell them you want to sign up for Progressive Auto with the Snapshot.  After your policy is in place you should receive your Snapshot device within 15 days.  Upon receipt of your device in the mail you should immediately plug it into your vehicle.  If you need assistance plugging in your device, your agent should be able to assist you.  Then, start saving!  Within the first 30 days of driving you should receive your first discount!  Keep the device plugged in though, as you will need to keep driving with it until Progressive sends you an email stating to send the device back.  Typically, you will send the device back after a full six months of driving.

Once Progressive has requested your device back you will be able to see what discount you will have applied to your policy for as long as you have the policy with Progressive.  Now, you might have to do it again in the future if Progressive asks you to.  But the good news is you could lock in up to 30% off your Auto insurance!

Make it fun!!  Have competitions in your household as who is the best driver, you will have proof now!! And for those young drivers, now you can educate them on what they are doing wrong in order to correct it and help them become better drivers!


My Opinion on Healthcare Reform…

By now we all have formed our own opinions of what we think about Healthcare Reform (aka ObamaCare).  But do we all really know how it will affect us?  Sure the highlights sound good, coverage for those with Pre-existing conditions, preventative care for everyone covered at 100%, penalties for those employers that do not offer us healthcare; yes, these all sound promising.  The question is will this really fix our healthcare system or make it worse?  Another key question is who is it going to affect the largest, or should I say who would it hit the homes of the fastest? 


I will take you through a few of the key components of the Healthcare reform and point out a few key thoughts from my perspective and the perspective of a bunch of my clients that I have spoken with over the year.  This is purely my opinion on how I feel this will affect our economy and my fears if we keep down the road without amending Healthcare Reform.  Notice, I am not saying “Repeal” it as our healthcare system is broke.  I feel America should fight for an amendment on Healthcare reform to be a more profitable and beneficial system to all participants.


Starting with the parts of the Affordable Care Act – Healthcare Reform, that I feel are very beneficial to the American people.


  1. Children can be covered under their parents plan until their 26th birthday regardless of school status.  This is very smart as in today’s society, not many children are graduating college or finding good career jobs prior to age 26.
  2. Unlimited Lifetime Maximums.  This one is also great, as policyholders paying premium for medical coverage should not be limited on their benefit over a lifetime for medical care.  As before with certain medical conditions, the lifetime maximum, expending on the diagnosis; could expire that maximum very quickly leaving a patient uninsured and uninsurable. 


There are other parts of this Act that I do agree with but feel they need tweaks in order to make them work better for society and the healthcare system.  For instance, the Preventative Care Coverage.  Yes, I enjoy getting my preventative exams covered at 100% just like everyone else; however, my question would be is it really free?  Lets put this in perspective:


Upon going to the doctor for a preventative exam, if we are insured it is covered at 100%.  This means we pay nothing to the doctor, facility or lab for the exam.  The doctor/facility; however, charges your insurance “x” amount of dollars for the visit and the lab charges “x” amount for the reading of your results.  You pay a monthly premium to your insurance for the ability to have that preventative exam covered at 100%.


So again, I ask are you really getting that preventative exam covered for free?  Now doctor’s offices are getting more people coming in for their preventative exams, which is good.  With more preventative exams being performed and insurance companies having to foot the bill for the exams, this can cause the healthcare costs to go up. Instead, I say keep some cost sharing to the policyholder.  Rather than paying an additional $10-$15 per month in premium to the insurance companies to have that exam covered at 100%, I would rather have a flat $10-$15 fee for the preventative exam I receive.  This fee would cover the full exam including any lab readings with no balance billing to the insured.  At this point the Employer could have an option to refund the employee for participating in preventative care by showing a receipt, or by offering rewards/incentives for being preventative.


Moving onto the next part of the bill I feel needs to be revisited is the Pre-Existing Condition Limitation. .  I agree that everyone has the right to have access to coverage.  The problem here is one that I have personally dealt with many of times.  There are individuals out there that are not responsible.  These individuals have had the ability to get insurance on more than one occasion but have instead decided they would rather spend the money elsewhere rather than on Health Insurance premium.  Now while being uninsured by choice over several years, some of these individuals have developed what we would call a pre-existing condition and need insurance but cannot find insurance to cover that without having to wait a 1-2 years on some plans for coverage on this condition.  Now, with healthcare reform we are telling them its okay that they have not been responsible over the years that we as already insured people will absorb their risk and pay into the system in order to cover their condition either by taxes or increased premiums on our own health insurance plans. 


Now, there is a flip side to this, there are insured’s that have had insurance, and have either lost their job, expired their COBRA coverage, or have been on an not “Creditable” insurance plan which causes them to have a pre-existing condition exclusion applied.  I completely agree with HealthCare Reform covering these people and all of their conditions with no pre-existing condition limitations as they have been paying into the healthcare system.  What people do not know is that some of the states already have plans for people who have this exact problem.  For example, the State of Texas has what is called the Texas State Health Risk Pool.  This covers anyone that cannot get coverage elsewhere.  The problem with the plan is it is too expensive.  Why doesn’t government contribute more to plans like this for the uninsurable in order to assist in the cost?


There are obviously parts I strongly disagree with, and I will keep this part short.  One important part of the Act that is coming to light effective as of all open enrollments January 1, 2013 is the change in the amounts employees can contribute to their FSA (Flexible Spending Accounts).  Now employees that participate in a FSA can only contribute $2,500 to their accounts regardless of whether they are individual or family.  This is huge for families that were contributing up to $5,000.  For those of you who are not aware of what a Flexible Spending Account is, this is a savings account that is set up through your employer on a “pre-tax” basis.  You are allowed to use these funds over the year for any Medical, Dental, Vision, or Pharmaceutical expenses that arise.  The idea of a FSA is typically to assist in the payment of medical deductibles; which typically run at a minimum of $1,500 per Individual and $3,000 per family.  Now for a family taking advantage of this FSA account is not as attractive as it was and will not save participants as much on tax dollars.


In regards to Small Business, one positive note is that any small business (meaning employs less than 25) offering health benefits to their employees will receive a tax credit as much as 35%.  This is to provide incentives for offering coverages to the employees.  If a company has over 50 full time employees and they do not offer health insurance to their employees they could be penalized come 2014.  What does this mean?  It means that if you’re a Small Business owner and you are currently employing 45 Employees, you will now either ask those employees to work harder and longer in order to avoid having to hire new employees.  Or as a business owner you will ask some of these employees to go “part-time” so that you can hire more “part-time” employees.  You as a business owner will do whatever it takes to not break the 50 employee threshold in order to avoid penalties should your company not have a Group Health Plan in place.


While these smaller businesses (employing under 50) won’t be penalized for not offering insurance to the employees, should the employees not have insurance they could be penalized individually on their taxes come 2014.  In order to help get people covered, I feel government should make insurance companies reduce their participation requirements.  This will not only help out Small Business’ to get their tax credits, but will allow more people to become covered.  Right now most insurance companies that sale to small businesses requires that you have 75% participation in a business in order to offer health insurance.  Many times in a small business you can get close but if you don’t meet the 75% then the insurance company will not allow that company to have group insurance.  This causes anywhere from 5-10 people or more per company to go uninsured, as typically group insurance is more affordable than individual insurance.  By changing the 75% to 50% participation requirement, I do feel we could improve the odds of some employees getting coverage and assist our Small Businesses in getting the tax credits they need.


Onto Medicare, we all agree, FIX IT!  Right now more doctors are refusing to take on Medicare patients than ever.  With healthcare reform, the fees that doctors can charge per service have been more restricted than ever.  With that being said, where will our Medicare Eligible people go for treatment?  The only true benefit to Medicare patients is the prescription drug part.  This is called Medicare Part D.  Here is where prescription drugs are better covered for participants and Healthcare Reform is trying to close the gap (Donut Hole) in coverage for participants.  This is excellent for their prescriptions, but what happens when their doctors won’t see them anymore due to the restricted fees they are allowed to charge for taking care of these participants?


This seems like a lot; however, it really doesn’t even scratch the surface on Healthcare Reform.  I have touched on some of the key factors about Healthcare Reform.  Should you want to know more about Healthcare Reform you should visit www.healthcare.gov.  Everyone needs to be educated when it comes to what our government is proposing, especially with elections right around the corner.