September 25, 2025 • 38 mins
There’s a lot of chatter out there. That's about the best way I can put it about what's going to happen with ACA. And, you know, I'm seeing pieces in the media that are portraying what's going to occur and the changes that are going to happen and how they're going to impact people, and unfortunately, there's a lot of false narrative out there. So I'm going to I'm going to explain where we're at on the individual health insurance market on Obamacare and ACA. Then I'm going to talk with two experts about what can you do to prepare yourself so that you're not caught up in a trap and you can't make a decision to solve the problem?
Then we’ll discuss give you the kind of coverage you need and how to find it.
That's what we're talking about in this episode, and that's the message we're trying to get out to everyone to is be prepared. This is coming. It's going to be like a tsunami. There going to be a lot of people displaced off of these plans are going to be looking for alternatives and so how do you deal with it, what are the best solutions and show you how you can do that and make sense of it for you and your family.
If you're an employer, what do you need to be looking at? Because the ACA plans for small group are going to get hit hard, hit just as hard as the individual plans are, if not harder in some cases.
This is episode 2126 of America’s Healthcare Advocate. I’m Cary Hall.
Learn more from our guests Carolee Steele and Maria Ahlers from RPS Benefits by Design:
Visit https://www.rpsbenefitsbydesigninc.com or call 877-385-2224
As always, if you need help or have something to share contact me with this form on my website and let me know what's on your mind, issues you are dealing with, or other health, healthcare, and health insurance questions and concerns. Visit: https://www.americashealthcareadvocate.com/contact-us
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
And now America's Healthcare Advocate,Cary Hall.
Hello, America.
Welcome to America's Healthcare Advocates,broadcasting coast to coast
across the USA here on the HIARadio Network.
You can find out more about us
by going to our website,AmericasHealthcareAdvocate.com.
All these shows are postedon your favorite podcast platforms
(00:21):
Spotify, SoundCloud, Rumble, you name it,we're on there.
And the YouTube platform America'sHealthcare Advocate.
My producers in studio. Mr.
Dave Thiessen behind all the camerastoday.
The man who puts all this together
gets it up on all the podcastand YouTube platforms.
And Garner Cowdreyhere from Cumulus, a recording today's
show and doing all the audio workso we can bring this out
(00:41):
to all of our affiliatesacross the country.
So in studio with metoday, Carolee Steele and Maria Ahlers,
from RPS Benefits by Design.
Welcome back for the.
I don't know what this the 50th show.
We feel like an old married couple.
We've been doing this for a while.
So what are we doing today?
Well,there's a lot of chatter out there. Okay.
(01:03):
That's about the best way I can put itabout what's going to happen with ACA.
And, you know, I'm seeing pieces
in the media that are portraying,you know, what's going to occur
and the changes that are going to happenand how they're going to impact people.
And unfortunately, there's a lot of falsenarrative out there.
So I'm going to I'm going to step in herefor a minute and kind of explain
(01:24):
where we're at on the individual healthinsurance market
on Obamacare and ACA, how we got here.
Okay. And then what does that look like?
So let's just start off with some facts,okay?
Between 2014 and 2019, benchmark premiums
for ACA plansincreased as much as 90%, 90%.
Okay. And we'll talk aboutwhy here in a little while.
(01:46):
Rural counties have been hitespecially hard.
52% of the countiesparticipating in Obamacare
only had one plan, because the carrierseither don't have the ability
to do a network or they can't get accessto care in those rural markets.
So there's another problem. All right.
So federal subsidies and this is where
(02:08):
it starts to become an issue.
Federal subsidies are now at a $100billion a year,
100 billion,which in ten years is $1.2 trillion.
So what we've got here, all right, iswe've got an unsustainable situation
that cannot continue.
And what prompted all this,what caused us to move
(02:28):
from wherethis thing was originally designed,
was the changes made in 2021 and on out,
where we moved the povertylevel up to 400% of the
of the annual poverty level,which means we increased,
increased the subsidies significantly.
And that's where we had a hugenumber of people enrolled in these plans,
(02:52):
because at that point,the subsidies' were up to as we as
I just talked about, okay, billionsof dollars that weren't planned for
this was as a result of Covid.
It was supposed to be temporary.
But you know as well as I do,anytime you introduce a government program
where you're handing peoplemoney, it's not going to be temporary.
Well, actually, it is this timebecause it's being pulled back.
(03:15):
Okay.
And what's happening isthe Trump administration
is bringing it backto what it was originally designed to do.
Now, that'snot what you're seeing in the press.
That's not what you're hearing.
You're hearing thatthe Trump administration is going to throw
8 million peopleoff of the Medicaid and ACA plans.
Okay, I broke that down on another show.
I'll very quicklyjust make sense out of this.
(03:37):
Over 1.4 million of those peopleare illegal aliens,
okay, that are on the planslike in California other places.
And the remainder of those peoplethat are going to be displaced on
these plans are people that are goingto lose those subsidies up to 400%.
The plan waswhen President Obama, qnd this passed.
Okay.
And John McCain was the passingvote in the Senate, pushed it through.
(03:58):
The idea was to give people subsidies upto 150 to 200% of the poverty level,
people that actually needed subsidiesto get health insurance.
It was never designed to goto 400% of the poverty level.
That's where it's at,and that's what's going to change.
So Carolee, there going to besome big disruptions in the marketplace.
Huge, huge, huge.
And just to reiterate,American Rescue Plan was enacted in 2021.
(04:22):
So they had basically, like yousaid, enhanced subsidies.
So they really weren't like trueto what they were prior to.
So with that, now if anybody doesn't knowwhat subsidies are, that's monies
that the government gives to the carrieron your behalf for part of that premium.
So your premium then is decreasedbecause of the subsidy that you
(04:44):
that they're giving to the carrier. Okay.
So currently enhanced subsidies arescheduled to expire at the end of 2025.
So what does that mean?
That means starting in 2026,millions could see just a huge jump,
an increase in the marketplace plansbecause their subsidy will go down.
And so, so from thereyou have a decreased financial assistance.
(05:07):
So and then from therewhat do you do from there?
You've got to come to one of usso that we can figure out
how to pivotor be able to look at other companies.
You may end up having to not havethe exact doctor you want if you're going,
if you can afford something
that has a more narrow network,you're going to have to probably do that.
(05:27):
Aetna is also dropping out of that market.
1 million people.
Well,yeah, 10,000 members in the metro here.
So Aetna
has 10,000.
So and they were kind of really SaintLuke's driven.
So you know going backwe're going to have to
look at other carriersthat might contract with Saint Luke's.
(05:47):
And so that's where that'swhere it comes for us.
So what you and we're referring hereto the Kansas City market, the show
broadcast nationwide.
This is happening in every marketacross the country. Correct.
We're just using this as an example.
But just moving from 400% of the povertylevel back to 150 or 200%.
That's where the big changeis going to come, is I said,
when President Obama passed this bill,it was never designed
(06:11):
for that piece of the marketplace,but it was enhanced by the Biden
administration when they moved this upto 400% of the poverty level.
And with the huge influx of people,you have 24 million
people on these plansnow that's going to change.
And what's happening is so let me give you
some examples of a couple thingsto kind of put this in perspective.
(06:32):
If you're a 52 year old male,but I'll use an example of a realtor
here in Leawood, Kansas, 52 yearold male wife, the same age, one child
made way too much money to get a subsidy,make him a significant
salary, is a very successful realtor.
His premium is $3,100a month, $3,100 a month.
He moved to a GigCare plan.
(06:54):
Okay, which is the plan offered by Detego.
Okay,a GigCare plan for $1,300 a month. Why?
Because we're
competingin the marketplace in a different way.
What's happeningis that people that aren't getting
subsidies are going off these plansbecause they become unaffordable.
Right. And then what's going to happen?
(07:15):
What's starting to happennow is what we call a death spiral.
You're going toand this is being referred to in the media
in a lot of places, the healthy peopleare coming off the plans.
Yes they are.
They're going to look for alternativeslike GigCare.
They're going to look for alternativeson the group side like ICHRA.
And we'll talk with Maria about thata little later on.
Okay.
But there are marketplace solutions outthere that are going to come into play.
(07:38):
They're going to startto change the dynamic here.
But this all centers around the factthat this was never designed,
okay, to be a completely governmentrun system.
Oh, are there are people that wanted that?
You bet there are.
The, you know, the group people in thiscountry that want Medicare for all.
And they think that solution, that's wherethey were hoping this is going to go.
What they didn't count on
(07:58):
was that the Trumpadministration was going to come in
and they were going to change this backto what it was originally meant to be.
So that's where we're at. Okay.
And then when I come back from the break,I'm going to talk with two experts now,
and we're going to start talking aboutwhat can you do to prepare yourself.
I don't care where you're at inthe country.
This is happening.
Okay.
So what can you do to prepare yourselfso that you're not caught up in a trap
(08:23):
and you can't make a decisionto solve the problem?
That's going to make sensefor you economically,
and going to give you the kind of coverageyou need.
That'swhat we're talking about here today,
and that's the messagewe're trying to get out to.
Everyone is be prepared.
This is coming.
It's going to be like a tsunami.
There going to be a lot of people
displaced off of these plansare going to be looking for alternatives.
(08:44):
And so how do you deal with that?
What's the best solution for that?
That's what we're here to talk about today
and show you how you can do thatand make sense of it for you, your family.
If you're an employer,what do you need to be looking at?
Because the ACA plans for small groupare going to get hit
hard, it just as hardas the individual plans are.
It's not harder in some cases.
So how are you going to prepare for that?
(09:05):
Stay tuned.We'll be right back after the break.
You're listening to America'sHealthcare Advocate
Broadcasting here on the HIARadio Network.
Coast to coast across the USA.
Stay right there. We've got more.
To. Welcome back.
(09:28):
You're listening to America's HealthcareAdvocate show broadcasting coast
to coast across the USA here on the HIARadio Network.
Want to say hello to our affiliatein Pensacola, Florida,
WNRP, AM 1260 and 95.3FM.
We're on 8:00 in the morning there onSaturday mornings in the Pensacola area.
Happy to be part of that familyin Pensacola, Florida.
(09:51):
Welcome on board.
Glad to have you. In studio with me today.
Carolee Steele and MariaAhlers from RPS Benefits by Design.
We're here to talk about all the changesthat are coming and they are coming,
which is why we're doing this show todaywell ahead of
what we're going to anticipate in the openenrollment period.
The changes that are coming to ACA,we've got changes coming in Medicare.
(10:13):
That's going to be a different show,but we really want to focus on ACA today,
Obamacare, ACA. Whatever you know it as.
Both on the small, on the smallgroup market and on the individual market.
How is it going to impactwhat's it going to look like?
So I'm going to roll through some of thenumbers here just to give you some idea.
So these are the carriers.
We're just going to use the KC metro.
(10:33):
But again I'm doing this.
So it's a you know,it's a microcosm of what's going on.
But this is going on around the country.
I'm just using this example.
So Celtic Insuranceis going to have a 24.4% increase.
Medica insurance 29.2% increase
Oscar 11.7% increase.
United Health Care 10.7.
(10:55):
Guess what?
Blue Cross and BlueShield of Kansas City -4.4
I'm going to repeat that blueCross and Blue shield of Kansas City -4.4.
So Blue Cross
Blue Shield of Kansas City is coming inwith a different plan in the marketplace.
We're going to talk aboutthat is the solution.
But to give you an ideathere's a lot of disruption coming up.
(11:16):
And when people lose these subsidies
you know,how are they going to respond to that?
How is that going to work?
Well, when you're looking
at these kinds of increases whichhave nothing to do with the subsidies,
these are just the increases
based on the fact that these carriersare having claims, they're outstripping
what they're bringing in, which is whyAetna pulled out of the market
after losing over $2 billion last year.
(11:40):
On the individual health insurance side.
They just couldn't do it anymore.
Okay. So you have two dynamics here.
One is reduced subsidies,the other is increasing costs,
that are associated with ACA
and that's impacting the marketplace.
So let's talk about this. So it looks like
you're going to see significant increasesacross the board.
(12:01):
And that to your pointit's going to stack.
So you've got increased premiums.
And then you have lowered subsidy.
So that's going to stack on thereto where their premiums
are going to be significantly higherbecause of that.
So blue cross and blueShield of Kansas City not unusual
that they would be innovativeand figure out a way to do this.
(12:22):
The, the, you know,the individually, operated not for profit
Blue Cross plans seem to have an abilityto do things like this, right?
Do innovative pieces.
And so as a result of that,
you know, here we're lookingat the only one in the marketplace.
It's going to have a -4.4.
So talk about this new planthat they're going to offer.
(12:43):
And yes, people are going to haveto make some adjustments.
But you're going to have a Blue Crossplan.
Let's talk about that.
And there is something to say about thatwith local customer service and things.
That is a huge plus.
So as far as like some of their planscurrently
have like a Blue SelectPlus that may pivot to a Blue Select.
So the market mean that the networkis going to be a little bit less,
(13:06):
but the premium is also going to be less.
So you have to kind of look to seewho are your non-negotiable doctors
and who do you wantwhat where can you kind of sacrifice
as far as going elsewhere.
So you're going to see access narrowed.
So you're going to have a narrow networkokay.
But you're still going
to have a great benefits program,but you're going to have to it,
you know, you may have to make a changein doctors to stay in that network.
(13:29):
The Blue Select and Blue SelectPlus are still pretty robust, except for
but the new new onethat they're coming out with
has a very narrow network,but a very low premium.
And so that is kind of they're innovative,you know,
to be able to add something to the marketbecause they know this is coming.
They know that people, you know,are going to be kind of
(13:51):
with those enhanced subsidies going away,they're going to have sticker shock
for sure.
And so that's why they've developedthis new plan, you know, and
so they're going to be ableto offer other options.
So that's one solutionthat's going to be in the marketplace.
Let's talk about another one.
GigCare which is offered by Detego.
I gave the example in the openingmonologue about the real estate
(14:13):
broker here.
So if you're making 150, 200 and $300,000a year, I know
there are a lot of you out there to do.
And youcan afford to do something different.
Maybe you don't want to pay $3,100 a monthfor three
people on plan,and you come to a plan like GigCare.
This is designedspecifically for 1099 people or.
(14:33):
W2 people that do not have coverageoffered, you know, from their company.
So they do not or their wife. Yes. Right.
So there there is a solution,that is significantly different.
Correct.
And the all of the marketplaceplans, well, at least in the KC Metro,
but very much, acrossthe nation as well, are EPO's.
(14:53):
That's exclusive provider organizations.
So there is no network outside of,you know,
you don't have to have like an HMO,you don't have to have referrals,
but there's no out of network coverageexcept for emergency.
And so that's where GigCare, you know,they have those,
but they've got Blue Card.
So anywhere you go in the United States
(15:16):
that offers like Preferred CareBlue, etc., you can go to those doctors.
I have people that travel to Florida.
They're doctors are in there.
Here, their doctors are in thereand that's huge because,
those EPO's, especially with restrictednetworks, are going to make a difference,
that you're going to have to pivot
and look elsewhereto see how you can get covered.
So the GigCare plans have an EPO modeland they have a straight PPO model.
(15:41):
And you're referring to the PPOmodel is the Blue Card model,
which is anywhere in the countryby the way,
you may not know this yet,so I'll announce that here on this show,
we are now going to havethe Aetna network.
And the Cigna network is optionsunder GigCare.
So it'll be an option for Aetna,Cigna and Blue Cross and Blue Shield
which is going to make a big differenceright.
Even if you have an EPO thoughlike if you're like we're
(16:03):
in the Kansas City metro,it's Blue Cross and Nebraska network.
So Blue Card will go anywhere here.
So even though it's a PPO and EPO,there's a little more flexibility
as far as a network is designedwhen you're outside with that Blue Card.
So again you knowyou're seeing some differences here.
There are solutions out there.
You're looking at the solution here fromBlue Cross Blue Shield to Kansas City.
(16:26):
We're talking about this GigCare solution.
When we come back from the break
I'm going to talk to Maria Ahlersabout a small group solution called ICHRA.
What does that mean.
How does that work?How can that benefit employers?
So we'll talk about that
and some of the other plansthat are out there
that are a little differentin their model,
but still offer good coverage for peopleso they can get these cost
(16:46):
controls in line and make sense out of it.
So I think there are solutions,but they're just not going to be
the solutions that have been out therefor the last five years.
And if you're a lazy broker andyou don't want to get off your rear end
and look at some of the other options,you can't just put this spreadsheet down
and say, here's, here's all, here'sthe deal.
Cross United, Cigna, Aetna (no longer)but plans and pick your poison.
(17:10):
You have to you have to be innovativeenough to look at opportunities.
You just have to look outside the boxand see what there is out there.
And that's where we come into play.And that's what these folks do.
I don't care where you're atin the country if you need help.
877-385-2224ask for the lovely Carolee Steele
if it’s on the ACA sideor the Medicare side.
If it's on the group side,
(17:31):
Maria Ahlers can certainly help you,or are one of the other folks
there will be happyto help you on the group side.
But they can make a differencebecause they're willing
to step out of the boxand look at things that are different .
877-385-2224or the website rpsbenefitsbydesigninc.com.
Go to the website,send them an email if you want help.
(17:52):
We'll be right back after the break.
You're listening to America's
Healthcare Advocate broadcasting coastto coast across the USA.
Stay right there.
Welcome back.
You're listening to America'sHealthcare Advocate
(18:14):
show broadcasting coastto coast across the USA.
All these shows are on our podcastplatform.
So Spotify, SoundCloud, TuneIn,you name it we’re on there.
Rumble, all of them.
And the YouTube channel.
Dave Thiessen
pulls all this together, gets it up therefor you and does a great job with this.
So you can tell somebody about this.
Hey, maybe it's your employerand you guys are not aware
(18:35):
a lot of people are not aware ofwhat's coming.
Have them go listen to the podcast,have them go look at the YouTube video
so they understand what's going to happenon the employer side.
And if it's, you know, we're talking aboutthe individual health insurance,
you know, if this is your husband,your wife, whatever the case may be,
your family,
you might want to have a conversationwith them, have them take a listen to this
and look for some alternatives.
(18:55):
If you just want some helpand a consultation.
877-385-2224 ask for Carolee.
If it's on the individual side.
If it's on the group side to askfor Maria, callers 877-385-2224 anywhere
in the country okay, doesn't matterwhere you are, they're happy to help you.
The website is rpsBenefitsByDesignInc.comif you want to go up on the website.
(19:19):
All right.
So the the changes on verification.
Let's get that first.And we're going to go right to group.
Give it on okay.
Consumers are required to verifytheir eligibility for a subsidized plan
each year now.
Or they have an additional $5monthly premium.
And that's new versus previous years.
And also they have to verifyprior to their, plan
(19:42):
starting that they have a proofof a qualified life event.
Like if you're losing employer coverage,
you have to provide proof firstbefore the plan will start, not after.
Okay.
So this is this has been comingfor some time because we had people.
I did a piece on this when I was,when I did the Medicare show.
You've got people on the ACA planthat are getting big subsidies.
(20:02):
And they're also over here on the Medicaidplan, two plans, same person.
Okay.
So there's a lot of fraudand waste going on here
because they weren't verifying anythingthat's changing.
Correct? Okay. They're
goingback to the way it was originally set up,
which when you
originally went on to an ACA plan,you had to present your tax return
to get a subsidy.
Well, when they opened this up in 2021,the all the rules went away
(20:26):
and it flooded this place.
That'swhy you got 24 million people on here now.
And there's going to be some shockand awe as a result of the changes.
All right. Let's switch gears.
So the small employer is the one that getspunished the most, Maria.
In this marketplace, you know,
the big employers 100 lives and above,we were talking about on break.
You can go to the Pareto Captive,you can go to Berkeley, you can, you know,
(20:48):
go to one of our plans on Detegothat are in the captive model.
And you can lower your costsand make a lot of sense.
The small employer, those 50 and belowthey’re other ones are getting clobbered.
What are the solutions to them like ICHRAand you talk about some of those.
Absolutely correct. Yes.
There are creative solutionsoutside of what we call the BUCAs, right.
(21:09):
The Blue Cross, Blue Shield,United, Cigna and Humana.
ICHRA, as you mentioned, Cary.
ICHRA stands for Individual CoverageHealth Reimbursement Arrangement.
And what that provides is instead,when you're on a
when you're on one of the big BUCA plans,
your employer contributes,
(21:29):
at least 50% to the premium.
What small business employers are doing is
sometimes that's a huge cost for them.
When they have to pay at least 50%,most of them will pay more because
they want to be competitive in the market.
So now what they're doing iswe're looking at ICHRA where the employer
sets a percentage or a flat rate of whatthey want to contribute
(21:53):
to an employeefor their premium health care.
Now, what that employee doesis that employee then takes that amount.
So say your employer wanted to contribute$300 a month to your premium.
You now have $300 a monthto go on your own
and find your own plan.
We can help do that.
(22:14):
We have partnershipswhere we will set it up on a platform,
with the amountthat the employer wants to to contribute.
Then the employee goes on to the platform,they know they have the $300.
They can shop with different carrierswith different plans.
They can pick
the amount of their deductible.
(22:34):
They can do the PPO,they can do a high deductible health plan,
and then they can enrolland they can see what their coverage is.
And then that $300 is contributed to their
monthly rate, and then the rest is takencare of by the employee.
So the beauty of this is instead ofpainting everybody with one brush, right.
So you got employees that are 25 years oldand you got employees
(22:54):
that are 60 years oldand they're all on the same plan.
Well,now they don't all need the same plan.
No 60 yearold doesn't need maternity benefits,
and they don't need accessto children's mercy.
So for them to go to this new narrownetwork Blue Cross plan
maybe would make a lot of sense. Okay.
But in order to navigate that,they have to understand what it is.
(23:16):
And that's where you all come inand say to the employer, hey,
you, you put the subsidy together.
We'll handle getting your peopleon the plans they need to be on.
Right? That's right.
You tell us how much you can affordwithin your budget.
We set it upand then your employees go on there,
and the plans are on therefor them to see, from different carriers,
different amounts, the network,and they pick what works for them.
(23:40):
See you.
I, I've saidthis is the thing I've used on this show
for years, size 44 overcoat doesn't fiteverybody.
Okay,so this is exactly what I'm talking about.
That gives the employer a fixed cost.
That's the whole idea.
And it gives the employeethe freedom to go pick what they want.
That's right. That's exactly.It makes a lot of sense.
(24:01):
It does.
And then the employees, if they need
help deciding what plan works for them,
that's where my team comes in and providesthat individual consulting.
Now, with RPSwe also work with Carolee, where
if we feel that
an ACAplan may be more beneficial for them,
(24:23):
then we'll refer them over to thatto our Solutions team to do that.
But it's a one stop shop, Cary.
We'll figure outwhat the best plan is for your employees.
Yeah.
Don't you know, don't try to negotiatethis yourself, okay?
It's complicated. Believe me.
I've been doing this for 30 years,
and it's getting more complicated,not less complicated,
because you got governmentright in the middle of this now,
(24:45):
and trying to sort through all thisto make sense out of it in the marketplace
is difficult.
Here's some other solutionsthat people are doing.
We've got we've got some new directprimary care clinics here in Kansas City.
Exemplar Care is part of Hy-Vee.
They're opening up new clinics here.
So what we're seeing is employers saying,you know what, I'm going to buy
(25:06):
that direct primary care, unlimited accessfor my employee and their family.
It's $91 a month, let's say, andthen I'll go buy a high deductible plan.
Let's talk abouthow would you marry those two up, like,
because I know you're doing this, the HRAand the HSA talk about that, Maria.
Yes, we can we can pick
(25:27):
pieces from different, plansto make it work for our clients.
So you can do a, as you mentioned, care.
You can do a direct providermembership for, for every day to day,
you know, the earinfections, the preventative,
the annual wellnessthat could be for that.
There are also providers that arethere's also programs
(25:50):
where you can do that virtually nowand you just pay a monthly fee,
and it covers all their day to day stuffas well as well as prescription.
But then we can also offer what we callcatastrophic plans,
where if somebody gets diagnosedwith a major medical condition,
then you have the catastrophic coveragethat can also help cover that.
(26:12):
There's HRA where, employers can pay
for first dollar coverage,or they can pay for the back end coverage.
There's a HSA accountwe've heard, actually.
Now people are
very much a proponent of HSA
where they're saving 20 to $30,000already to
(26:32):
cover their medical expenses.
There is GigCare to helpwith the solutions?
There's level funded.
Most companiesnow are trying to get away from the ACA
because they are they are age rated.
Are they are set
And you're goingto see your employers that
(26:55):
when you've got reasonably healthy groupsare going to start looking for a way out.
That's right.
They want to get off.
They wantthey've got to find something that works.
This thing is not sustainablethe way it is now.
But as a broker you have to be willingto step outside the box.
Yet be willing to listento what somebody is dealing with.
How do I solve the problem.
(27:15):
And here's the set of solutions.
There's so many solutions we can
implement.
You know, we've done a gap planto help with the larger,
high deductible health plans where we addthat as a plan for our clients.
And that helps cover the gap betweenthe deductible between the two plans.
(27:38):
There's just a lot of creative solutions.
We just need to know what your needs are,what your pain points
are, and let's get togetherand figure out the different options.
Here's the thing, okay?
You have to be,you've got to be proactive here.
Don't wait until you knowrenewal hits you with a 25% increase.
(27:58):
Or a 29% increase from Medica or Celticor one of the other ones.
Okay, now's the time to act.
Start a consultation,give them a call, get ahold of Maria.
Get Ahold of Carolee.
877-385-2224.
It doesn't cost you anythingto talk to these folks, okay?
And they can help you get a solution.
(28:20):
That's going to make sense, butyou have to get in front of it, not do it.
At the end of the situationwhere now you've got to renewal
and you don't have any timeto make a decent decision.
So once again, 877-385-2224
or their websiteRPSBenefitsbyDesignInc.com.
rpsbenefitsbydesigninc.com.
When I come back we're going to explainHSAs so you understand how they work
(28:43):
and these HRAs and how you can incorporatethose and keep benefits
for a major network, but have that benefitif you have a catastrophic illness.
Stay tuned.We'll be right back after the break.
You're listening to America'sHealthcare Advocate
Broadcasting here on the HIARadio Network.
Coast to coast across the USA.
(29:09):
Welcome back.
You're listening to America's HealthcareAdvocate show, broadcasting coast
to coast across the USA here on the HIARadio Network.
My producer, Mr. Garner Cowdery,behind the microphone.
Dave Thiessen behind all the cameras.
Putting all this together.
For all of you out there in our audience,on our podcast channels, YouTube
channels, and across the airon all of our terrestrial radio stations.
(29:29):
In studio with me, Carolee Steele andMaria Ahlers from RPS Benefits by Design.
We're telling you, get prepared.
It's coming. It's going to be a tsunami.
It's coming.
Don'twait until you're caught up in it, okay?
These people can helpyou navigate through.
The sky is not falling.
It's not the end of the world, okay?
But you've got to prepare yourselfand if you're the employer, for God's
(29:53):
sake, pick up the phoneand give these folks a call.
If you're an individualand you're concerned
and maybe you're one of those Aetnapeople, you're losing coverage altogether.
Okay, well, give them a call.
They're happy to help.
877-385-2224 they are experts.
They do this nationally.
Okay?
877-385-2224
(30:13):
or the website rpsbenefitsbydesigninc.com.
You know, HSAs were introducedI don't know was it 15 years ago?
Something like that.
And it was a hard conceptfor people to grasp.
Correct.
But when you look at how they functionversus how
what I call the American Express Plan,where you have your American Express card,
you don't have to you walk inand make a $10 co-pay and you're done.
(30:36):
Well, those days are gone.
Yeah, that's why the premiumsare going through the roof.
Let's talk about how the HSA works,why is it beneficial
and why are a lot of peoplemoving to those plans?
Well, I think it’s wonderful.I have an HSA.
So what HSA is, is thatyou can put monies away
every year toward, it's a certain amountdepending on if you are single.
(30:59):
It’s up to $6,300 a year.
Or a family, you can put that away.
It's typically you've got to,
everything comes out of pocketuntil you meet that deductible.
And then there's a percentagefor insurance.
Typically the
employer offers an HSA that
is a reduced premium compared to the otherstandard traditional plans.
(31:20):
So that was one good.
It also, you can use that money.
It rolls over to the following year.
So it's not a use it or lose itat the end of the year.
Correct, it's not a flex spending account.
It is an HSA account. Yes.
And this is really wonderfulbecause if you have a family,
your daughter needs to have her
teeth pulled to get something for wisdomteeth pulled.
(31:42):
You can use that as long as they're taxdependents in the family.
You can usethose HSA funds toward that as well.
And here's the thing.
When you put the money in there,it's a tax deduction.
Right.
So if you put $6,300 in there you justtook $6,300 off of your tax liability.
Correct. It's a tax deduction.
That's huge. And Maria, once you hit a.
(32:04):
Certain amount you can invest that moneyin the money market.
I didn't know that. You can.
So there's another option. Yeah.
So the money stacks up.
You get pastyour first year, you've got enough
to cover the deductible coinsurancetypically down the road.
Okay.
As you continue to add to it, you'rebuilding an account.
(32:25):
And as you said you can invest that moneyMaria.
So this is an opportunity individual side.
So tax deductible going in tax freecoming out.
You can use it for more than health care.
You can use it for dental.
You can use it to buy glasses.
You can use itfor a host of different things right.
You get a debit card.You have an HSA account.
That's how it works.
How does this work for employers?
(32:45):
Now, Maria, in terms of you talked in thelast segment, if you drop premiums 30%,
the employer can afford to say,
you know what, if you got an HSA, I'mgoing to go ahead and add another $100
a month to this for your HSA accountto encourage people do it.
Does that make sense?
There's a lot of different strategies,Cary, that we work with our clients.
(33:07):
We have clients where they do, a highdeductible health plan, offer an HSA,
and then they contribute 100%to the employee's HSA to help
with their costs up to their deductible.
We have clients that will, embed an HRA,
which where they'll cover again,if your deductible is $3,000,
(33:29):
that employer will cover, will decidethey'll cover the first,
maybe the first 1500 of your deductible,or they'll cover the back
1500 of your deductible.
But these are creative strategiesthat we work with our clients
to make it work for them, but yet
provide them with comprehensivecoverage for their employees.
(33:49):
So yeah, there'sthere's it's it's all about strategy.
And I think the point that you madeearlier is we need to start on it
proactively.
Most employers will waituntil they get their renewal.
Well then we only got 60 days.
And with that 60 dayswe have to strategize,
look at different options, go to market,look at the financial analysis.
(34:12):
The other piece to this that some of ourclients don't, recognize that we've,
put into play a lot is critical illnessand accident and hospital indemnity.
Those lines of coveragehelp with the medical costs as well.
So there are ways to blend those in.
And therethose are relatively inexpensive.
Relatively inexpensive.
I had a cancer plan forI don't know how many years it was.
(34:35):
I had a bulk cancer plan of $50,000,
and the way it worked was, I hate Aflac,just so we all know I like ducks.
I prefer it with orange sauce. Yes, but
you know, I don't like the Aflac modelbecause what they do
is you have to send in your claimsand then they reimburse you.
The model that I had was onceI was diagnosed
(34:56):
with cancer, and the actual diagnosiswent into the carrier.
I got a check three days later, period.
And you can spend it
on whatever you like.
Whatever I wanted.
If wanted to go sit
on a beach in Mexico and decide, okay,this is where I'm going to finish it up.
That's right.
I've got terminal cancer.
That was my money to do what I want with.
But that was a very inexpensive policy.
(35:18):
But it gave me peace of mind.
Because we know bills don't stopjust because you're in the hospital. No.
And to piggyback on that, asfar as having your, like a critical, like,
cancer, stroke and heart, you may haveyou may have a Medicare supplement.
So you don't have
a lot of medical out-of-pocket,but you may have to go to Mayo Clinic,
and you're goingto have to stay in a hotel,
(35:38):
and you're going to have to fly there,and you're going to have to do all that.
So that is also used.
That money can be used forthat as well. Yeah.
So I think what we're trying to say hereis we're wrapping this up today.
And thank you both to meand Maria and Carolee.
You know, it'sgreat to have experts in studio
that can really walk youthrough this stuff.
It's complicated,but this is why I do these broadcasts.
(35:58):
And I bring people on here that canexplain this to make sense out of it.
So you're looking for a solution?
You heard Maria just say this.
Here's what happens.
Everybody waitsuntil those renewal notices
hit or ACA open enrollment startsand then they start calling.
Well, you're not the only one okay.
You know. Yeah.The phones are melting down.
(36:19):
I remember doing this backwhen I ran Benefits by Design.
And literallythe phones would be melting down
with people in a panictrying to get this done.
This year's going to be worse.
That'swhy I'm doing this show way ahead of time.
Okay.
So you know that it's coming.
And prepare yourself.
If you're an individual, you need help.
Get ahold of Carolee, 877-385-2224.
(36:42):
If you're an employer, you just heardMaria walk through how they do this.
They do a full blown analysis.
This is a come in and laya spreadsheet down.
They comein, they do a full blown analysis,
come back to youwith a series of solutions,
and then you pickthe one you think makes the most sense.
That's what I'm suggesting you do.
877-385-2224 is their phone number.
(37:03):
Their websiteis rpsbenefitsbydesigninc.com.
If you are one of the folksthat are facing these kinds of renewals
and what's happening,now's the time to reach out to them.
And now I leave youwith this thought from Albert Einstein,
the one who follows the crowd theyusually get no further than the crowd.
The one who walks alone will likely findhimself in places no one has ever been.
(37:24):
Remember,friends it’s a funny thing about life,
if you refuse to accept anythingbut the very best, you most often get it.
Thank you for listening to America'sHealthcare Advocate Show,
broadcasting coast to coast across the USAhere on the HIA Radio Network.
Goodbye America.
And now America's Healthcare Advocate,Cary Hall.
Hello, America.
Welcome to America's Healthcare Advocates,broadcasting coast to coast
across the USA here on the HIARadio Network.
You can find out more about us
by going to our website,AmericasHealthcareAdvocate.com.
All these shows are postedon your favorite podcast platforms
(00:21):
Spotify, SoundCloud, Rumble, you name it,we're on there.
And the YouTube platform America'sHealthcare Advocate.
My producers in studio. Mr.
Dave Thiessen behind all the camerastoday.
The man who puts all this together
gets it up on all the podcastand YouTube platforms.
And Garner Cowdreyhere from Cumulus, a recording today's
show and doing all the audio workso we can bring this out
(00:41):
to all of our affiliatesacross the country.
So in studio with metoday, Carolee Steele and Maria Ahlers,
from RPS Benefits by Design.
Welcome back for the.
I don't know what this the 50th show.
We feel like an old married couple.
We've been doing this for a while.
So what are we doing today?
Well,there's a lot of chatter out there. Okay.
(01:03):
That's about the best way I can put itabout what's going to happen with ACA.
And, you know, I'm seeing pieces
in the media that are portraying,you know, what's going to occur
and the changes that are going to happenand how they're going to impact people.
And unfortunately, there's a lot of falsenarrative out there.
So I'm going to I'm going to step in herefor a minute and kind of explain
(01:24):
where we're at on the individual healthinsurance market
on Obamacare and ACA, how we got here.
Okay. And then what does that look like?
So let's just start off with some facts,okay?
Between 2014 and 2019, benchmark premiums
for ACA plansincreased as much as 90%, 90%.
Okay. And we'll talk aboutwhy here in a little while.
(01:46):
Rural counties have been hitespecially hard.
52% of the countiesparticipating in Obamacare
only had one plan, because the carrierseither don't have the ability
to do a network or they can't get accessto care in those rural markets.
So there's another problem. All right.
So federal subsidies and this is where
(02:08):
it starts to become an issue.
Federal subsidies are now at a $100billion a year,
100 billion,which in ten years is $1.2 trillion.
So what we've got here, all right, iswe've got an unsustainable situation
that cannot continue.
And what prompted all this,what caused us to move
(02:28):
from wherethis thing was originally designed,
was the changes made in 2021 and on out,
where we moved the povertylevel up to 400% of the
of the annual poverty level,which means we increased,
increased the subsidies significantly.
And that's where we had a hugenumber of people enrolled in these plans,
(02:52):
because at that point,the subsidies' were up to as we as
I just talked about, okay, billionsof dollars that weren't planned for
this was as a result of Covid.
It was supposed to be temporary.
But you know as well as I do,anytime you introduce a government program
where you're handing peoplemoney, it's not going to be temporary.
Well, actually, it is this timebecause it's being pulled back.
(03:15):
Okay.
And what's happening isthe Trump administration
is bringing it backto what it was originally designed to do.
Now, that'snot what you're seeing in the press.
That's not what you're hearing.
You're hearing thatthe Trump administration is going to throw
8 million peopleoff of the Medicaid and ACA plans.
Okay, I broke that down on another show.
I'll very quicklyjust make sense out of this.
(03:37):
Over 1.4 million of those peopleare illegal aliens,
okay, that are on the planslike in California other places.
And the remainder of those peoplethat are going to be displaced on
these plans are people that are goingto lose those subsidies up to 400%.
The plan waswhen President Obama, qnd this passed.
Okay.
And John McCain was the passingvote in the Senate, pushed it through.
(03:58):
The idea was to give people subsidies upto 150 to 200% of the poverty level,
people that actually needed subsidiesto get health insurance.
It was never designed to goto 400% of the poverty level.
That's where it's at,and that's what's going to change.
So Carolee, there going to besome big disruptions in the marketplace.
Huge, huge, huge.
And just to reiterate,American Rescue Plan was enacted in 2021.
(04:22):
So they had basically, like yousaid, enhanced subsidies.
So they really weren't like trueto what they were prior to.
So with that, now if anybody doesn't knowwhat subsidies are, that's monies
that the government gives to the carrieron your behalf for part of that premium.
So your premium then is decreasedbecause of the subsidy that you
(04:44):
that they're giving to the carrier. Okay.
So currently enhanced subsidies arescheduled to expire at the end of 2025.
So what does that mean?
That means starting in 2026,millions could see just a huge jump,
an increase in the marketplace plansbecause their subsidy will go down.
And so, so from thereyou have a decreased financial assistance.
(05:07):
So and then from therewhat do you do from there?
You've got to come to one of usso that we can figure out
how to pivotor be able to look at other companies.
You may end up having to not havethe exact doctor you want if you're going,
if you can afford something
that has a more narrow network,you're going to have to probably do that.
(05:27):
Aetna is also dropping out of that market.
1 million people.
Well,yeah, 10,000 members in the metro here.
So Aetna
has 10,000.
So and they were kind of really SaintLuke's driven.
So you know going backwe're going to have to
look at other carriersthat might contract with Saint Luke's.
(05:47):
And so that's where that'swhere it comes for us.
So what you and we're referring hereto the Kansas City market, the show
broadcast nationwide.
This is happening in every marketacross the country. Correct.
We're just using this as an example.
But just moving from 400% of the povertylevel back to 150 or 200%.
That's where the big changeis going to come, is I said,
when President Obama passed this bill,it was never designed
(06:11):
for that piece of the marketplace,but it was enhanced by the Biden
administration when they moved this upto 400% of the poverty level.
And with the huge influx of people,you have 24 million
people on these plansnow that's going to change.
And what's happening is so let me give you
some examples of a couple thingsto kind of put this in perspective.
(06:32):
If you're a 52 year old male,but I'll use an example of a realtor
here in Leawood, Kansas, 52 yearold male wife, the same age, one child
made way too much money to get a subsidy,make him a significant
salary, is a very successful realtor.
His premium is $3,100a month, $3,100 a month.
He moved to a GigCare plan.
(06:54):
Okay, which is the plan offered by Detego.
Okay,a GigCare plan for $1,300 a month. Why?
Because we're
competingin the marketplace in a different way.
What's happeningis that people that aren't getting
subsidies are going off these plansbecause they become unaffordable.
Right. And then what's going to happen?
(07:15):
What's starting to happennow is what we call a death spiral.
You're going toand this is being referred to in the media
in a lot of places, the healthy peopleare coming off the plans.
Yes they are.
They're going to look for alternativeslike GigCare.
They're going to look for alternativeson the group side like ICHRA.
And we'll talk with Maria about thata little later on.
Okay.
But there are marketplace solutions outthere that are going to come into play.
(07:38):
They're going to startto change the dynamic here.
But this all centers around the factthat this was never designed,
okay, to be a completely governmentrun system.
Oh, are there are people that wanted that?
You bet there are.
The, you know, the group people in thiscountry that want Medicare for all.
And they think that solution, that's wherethey were hoping this is going to go.
What they didn't count on
(07:58):
was that the Trumpadministration was going to come in
and they were going to change this backto what it was originally meant to be.
So that's where we're at. Okay.
And then when I come back from the break,I'm going to talk with two experts now,
and we're going to start talking aboutwhat can you do to prepare yourself.
I don't care where you're at inthe country.
This is happening.
Okay.
So what can you do to prepare yourselfso that you're not caught up in a trap
(08:23):
and you can't make a decisionto solve the problem?
That's going to make sensefor you economically,
and going to give you the kind of coverageyou need.
That'swhat we're talking about here today,
and that's the messagewe're trying to get out to.
Everyone is be prepared.
This is coming.
It's going to be like a tsunami.
There going to be a lot of people
displaced off of these plansare going to be looking for alternatives.
(08:44):
And so how do you deal with that?
What's the best solution for that?
That's what we're here to talk about today
and show you how you can do thatand make sense of it for you, your family.
If you're an employer,what do you need to be looking at?
Because the ACA plans for small groupare going to get hit
hard, it just as hardas the individual plans are.
It's not harder in some cases.
So how are you going to prepare for that?
(09:05):
Stay tuned.We'll be right back after the break.
You're listening to America'sHealthcare Advocate
Broadcasting here on the HIARadio Network.
Coast to coast across the USA.
Stay right there. We've got more.
To. Welcome back.
(09:28):
You're listening to America's HealthcareAdvocate show broadcasting coast
to coast across the USA here on the HIARadio Network.
Want to say hello to our affiliatein Pensacola, Florida,
WNRP, AM 1260 and 95.3FM.
We're on 8:00 in the morning there onSaturday mornings in the Pensacola area.
Happy to be part of that familyin Pensacola, Florida.
(09:51):
Welcome on board.
Glad to have you. In studio with me today.
Carolee Steele and MariaAhlers from RPS Benefits by Design.
We're here to talk about all the changesthat are coming and they are coming,
which is why we're doing this show todaywell ahead of
what we're going to anticipate in the openenrollment period.
The changes that are coming to ACA,we've got changes coming in Medicare.
(10:13):
That's going to be a different show,but we really want to focus on ACA today,
Obamacare, ACA. Whatever you know it as.
Both on the small, on the smallgroup market and on the individual market.
How is it going to impactwhat's it going to look like?
So I'm going to roll through some of thenumbers here just to give you some idea.
So these are the carriers.
We're just going to use the KC metro.
(10:33):
But again I'm doing this.
So it's a you know,it's a microcosm of what's going on.
But this is going on around the country.
I'm just using this example.
So Celtic Insuranceis going to have a 24.4% increase.
Medica insurance 29.2% increase
Oscar 11.7% increase.
United Health Care 10.7.
(10:55):
Guess what?
Blue Cross and BlueShield of Kansas City -4.4
I'm going to repeat that blueCross and Blue shield of Kansas City -4.4.
So Blue Cross
Blue Shield of Kansas City is coming inwith a different plan in the marketplace.
We're going to talk aboutthat is the solution.
But to give you an ideathere's a lot of disruption coming up.
(11:16):
And when people lose these subsidies
you know,how are they going to respond to that?
How is that going to work?
Well, when you're looking
at these kinds of increases whichhave nothing to do with the subsidies,
these are just the increases
based on the fact that these carriersare having claims, they're outstripping
what they're bringing in, which is whyAetna pulled out of the market
after losing over $2 billion last year.
(11:40):
On the individual health insurance side.
They just couldn't do it anymore.
Okay. So you have two dynamics here.
One is reduced subsidies,the other is increasing costs,
that are associated with ACA
and that's impacting the marketplace.
So let's talk about this. So it looks like
you're going to see significant increasesacross the board.
(12:01):
And that to your pointit's going to stack.
So you've got increased premiums.
And then you have lowered subsidy.
So that's going to stack on thereto where their premiums
are going to be significantly higherbecause of that.
So blue cross and blueShield of Kansas City not unusual
that they would be innovativeand figure out a way to do this.
(12:22):
The, the, you know,the individually, operated not for profit
Blue Cross plans seem to have an abilityto do things like this, right?
Do innovative pieces.
And so as a result of that,
you know, here we're lookingat the only one in the marketplace.
It's going to have a -4.4.
So talk about this new planthat they're going to offer.
(12:43):
And yes, people are going to haveto make some adjustments.
But you're going to have a Blue Crossplan.
Let's talk about that.
And there is something to say about thatwith local customer service and things.
That is a huge plus.
So as far as like some of their planscurrently
have like a Blue SelectPlus that may pivot to a Blue Select.
So the market mean that the networkis going to be a little bit less,
(13:06):
but the premium is also going to be less.
So you have to kind of look to seewho are your non-negotiable doctors
and who do you wantwhat where can you kind of sacrifice
as far as going elsewhere.
So you're going to see access narrowed.
So you're going to have a narrow networkokay.
But you're still going
to have a great benefits program,but you're going to have to it,
you know, you may have to make a changein doctors to stay in that network.
(13:29):
The Blue Select and Blue SelectPlus are still pretty robust, except for
but the new new onethat they're coming out with
has a very narrow network,but a very low premium.
And so that is kind of they're innovative,you know,
to be able to add something to the marketbecause they know this is coming.
They know that people, you know,are going to be kind of
(13:51):
with those enhanced subsidies going away,they're going to have sticker shock
for sure.
And so that's why they've developedthis new plan, you know, and
so they're going to be ableto offer other options.
So that's one solutionthat's going to be in the marketplace.
Let's talk about another one.
GigCare which is offered by Detego.
I gave the example in the openingmonologue about the real estate
(14:13):
broker here.
So if you're making 150, 200 and $300,000a year, I know
there are a lot of you out there to do.
And youcan afford to do something different.
Maybe you don't want to pay $3,100 a monthfor three
people on plan,and you come to a plan like GigCare.
This is designedspecifically for 1099 people or.
(14:33):
W2 people that do not have coverageoffered, you know, from their company.
So they do not or their wife. Yes. Right.
So there there is a solution,that is significantly different.
Correct.
And the all of the marketplaceplans, well, at least in the KC Metro,
but very much, acrossthe nation as well, are EPO's.
(14:53):
That's exclusive provider organizations.
So there is no network outside of,you know,
you don't have to have like an HMO,you don't have to have referrals,
but there's no out of network coverageexcept for emergency.
And so that's where GigCare, you know,they have those,
but they've got Blue Card.
So anywhere you go in the United States
(15:16):
that offers like Preferred CareBlue, etc., you can go to those doctors.
I have people that travel to Florida.
They're doctors are in there.
Here, their doctors are in thereand that's huge because,
those EPO's, especially with restrictednetworks, are going to make a difference,
that you're going to have to pivot
and look elsewhereto see how you can get covered.
So the GigCare plans have an EPO modeland they have a straight PPO model.
(15:41):
And you're referring to the PPOmodel is the Blue Card model,
which is anywhere in the countryby the way,
you may not know this yet,so I'll announce that here on this show,
we are now going to havethe Aetna network.
And the Cigna network is optionsunder GigCare.
So it'll be an option for Aetna,Cigna and Blue Cross and Blue Shield
which is going to make a big differenceright.
Even if you have an EPO thoughlike if you're like we're
(16:03):
in the Kansas City metro,it's Blue Cross and Nebraska network.
So Blue Card will go anywhere here.
So even though it's a PPO and EPO,there's a little more flexibility
as far as a network is designedwhen you're outside with that Blue Card.
So again you knowyou're seeing some differences here.
There are solutions out there.
You're looking at the solution here fromBlue Cross Blue Shield to Kansas City.
(16:26):
We're talking about this GigCare solution.
When we come back from the break
I'm going to talk to Maria Ahlersabout a small group solution called ICHRA.
What does that mean.
How does that work?How can that benefit employers?
So we'll talk about that
and some of the other plansthat are out there
that are a little differentin their model,
but still offer good coverage for peopleso they can get these cost
(16:46):
controls in line and make sense out of it.
So I think there are solutions,but they're just not going to be
the solutions that have been out therefor the last five years.
And if you're a lazy broker andyou don't want to get off your rear end
and look at some of the other options,you can't just put this spreadsheet down
and say, here's, here's all, here'sthe deal.
Cross United, Cigna, Aetna (no longer)but plans and pick your poison.
(17:10):
You have to you have to be innovativeenough to look at opportunities.
You just have to look outside the boxand see what there is out there.
And that's where we come into play.And that's what these folks do.
I don't care where you're atin the country if you need help.
877-385-2224ask for the lovely Carolee Steele
if it’s on the ACA sideor the Medicare side.
If it's on the group side,
(17:31):
Maria Ahlers can certainly help you,or are one of the other folks
there will be happyto help you on the group side.
But they can make a differencebecause they're willing
to step out of the boxand look at things that are different .
877-385-2224or the website rpsbenefitsbydesigninc.com.
Go to the website,send them an email if you want help.
(17:52):
We'll be right back after the break.
You're listening to America's
Healthcare Advocate broadcasting coastto coast across the USA.
Stay right there.
Welcome back.
You're listening to America'sHealthcare Advocate
(18:14):
show broadcasting coastto coast across the USA.
All these shows are on our podcastplatform.
So Spotify, SoundCloud, TuneIn,you name it we’re on there.
Rumble, all of them.
And the YouTube channel.
Dave Thiessen
pulls all this together, gets it up therefor you and does a great job with this.
So you can tell somebody about this.
Hey, maybe it's your employerand you guys are not aware
(18:35):
a lot of people are not aware ofwhat's coming.
Have them go listen to the podcast,have them go look at the YouTube video
so they understand what's going to happenon the employer side.
And if it's, you know, we're talking aboutthe individual health insurance,
you know, if this is your husband,your wife, whatever the case may be,
your family,
you might want to have a conversationwith them, have them take a listen to this
and look for some alternatives.
(18:55):
If you just want some helpand a consultation.
877-385-2224 ask for Carolee.
If it's on the individual side.
If it's on the group side to askfor Maria, callers 877-385-2224 anywhere
in the country okay, doesn't matterwhere you are, they're happy to help you.
The website is rpsBenefitsByDesignInc.comif you want to go up on the website.
(19:19):
All right.
So the the changes on verification.
Let's get that first.And we're going to go right to group.
Give it on okay.
Consumers are required to verifytheir eligibility for a subsidized plan
each year now.
Or they have an additional $5monthly premium.
And that's new versus previous years.
And also they have to verifyprior to their, plan
(19:42):
starting that they have a proofof a qualified life event.
Like if you're losing employer coverage,
you have to provide proof firstbefore the plan will start, not after.
Okay.
So this is this has been comingfor some time because we had people.
I did a piece on this when I was,when I did the Medicare show.
You've got people on the ACA planthat are getting big subsidies.
(20:02):
And they're also over here on the Medicaidplan, two plans, same person.
Okay.
So there's a lot of fraudand waste going on here
because they weren't verifying anythingthat's changing.
Correct? Okay. They're
goingback to the way it was originally set up,
which when you
originally went on to an ACA plan,you had to present your tax return
to get a subsidy.
Well, when they opened this up in 2021,the all the rules went away
(20:26):
and it flooded this place.
That'swhy you got 24 million people on here now.
And there's going to be some shockand awe as a result of the changes.
All right. Let's switch gears.
So the small employer is the one that getspunished the most, Maria.
In this marketplace, you know,
the big employers 100 lives and above,we were talking about on break.
You can go to the Pareto Captive,you can go to Berkeley, you can, you know,
(20:48):
go to one of our plans on Detegothat are in the captive model.
And you can lower your costsand make a lot of sense.
The small employer, those 50 and belowthey’re other ones are getting clobbered.
What are the solutions to them like ICHRAand you talk about some of those.
Absolutely correct. Yes.
There are creative solutionsoutside of what we call the BUCAs, right.
(21:09):
The Blue Cross, Blue Shield,United, Cigna and Humana.
ICHRA, as you mentioned, Cary.
ICHRA stands for Individual CoverageHealth Reimbursement Arrangement.
And what that provides is instead,when you're on a
when you're on one of the big BUCA plans,
your employer contributes,
(21:29):
at least 50% to the premium.
What small business employers are doing is
sometimes that's a huge cost for them.
When they have to pay at least 50%,most of them will pay more because
they want to be competitive in the market.
So now what they're doing iswe're looking at ICHRA where the employer
sets a percentage or a flat rate of whatthey want to contribute
(21:53):
to an employeefor their premium health care.
Now, what that employee doesis that employee then takes that amount.
So say your employer wanted to contribute$300 a month to your premium.
You now have $300 a monthto go on your own
and find your own plan.
We can help do that.
(22:14):
We have partnershipswhere we will set it up on a platform,
with the amountthat the employer wants to to contribute.
Then the employee goes on to the platform,they know they have the $300.
They can shop with different carrierswith different plans.
They can pick
the amount of their deductible.
(22:34):
They can do the PPO,they can do a high deductible health plan,
and then they can enrolland they can see what their coverage is.
And then that $300 is contributed to their
monthly rate, and then the rest is takencare of by the employee.
So the beauty of this is instead ofpainting everybody with one brush, right.
So you got employees that are 25 years oldand you got employees
(22:54):
that are 60 years oldand they're all on the same plan.
Well,now they don't all need the same plan.
No 60 yearold doesn't need maternity benefits,
and they don't need accessto children's mercy.
So for them to go to this new narrownetwork Blue Cross plan
maybe would make a lot of sense. Okay.
But in order to navigate that,they have to understand what it is.
(23:16):
And that's where you all come inand say to the employer, hey,
you, you put the subsidy together.
We'll handle getting your peopleon the plans they need to be on.
Right? That's right.
You tell us how much you can affordwithin your budget.
We set it upand then your employees go on there,
and the plans are on therefor them to see, from different carriers,
different amounts, the network,and they pick what works for them.
(23:40):
See you.
I, I've saidthis is the thing I've used on this show
for years, size 44 overcoat doesn't fiteverybody.
Okay,so this is exactly what I'm talking about.
That gives the employer a fixed cost.
That's the whole idea.
And it gives the employeethe freedom to go pick what they want.
That's right. That's exactly.It makes a lot of sense.
(24:01):
It does.
And then the employees, if they need
help deciding what plan works for them,
that's where my team comes in and providesthat individual consulting.
Now, with RPSwe also work with Carolee, where
if we feel that
an ACAplan may be more beneficial for them,
(24:23):
then we'll refer them over to thatto our Solutions team to do that.
But it's a one stop shop, Cary.
We'll figure outwhat the best plan is for your employees.
Yeah.
Don't you know, don't try to negotiatethis yourself, okay?
It's complicated. Believe me.
I've been doing this for 30 years,
and it's getting more complicated,not less complicated,
because you got governmentright in the middle of this now,
(24:45):
and trying to sort through all thisto make sense out of it in the marketplace
is difficult.
Here's some other solutionsthat people are doing.
We've got we've got some new directprimary care clinics here in Kansas City.
Exemplar Care is part of Hy-Vee.
They're opening up new clinics here.
So what we're seeing is employers saying,you know what, I'm going to buy
(25:06):
that direct primary care, unlimited accessfor my employee and their family.
It's $91 a month, let's say, andthen I'll go buy a high deductible plan.
Let's talk abouthow would you marry those two up, like,
because I know you're doing this, the HRAand the HSA talk about that, Maria.
Yes, we can we can pick
(25:27):
pieces from different, plansto make it work for our clients.
So you can do a, as you mentioned, care.
You can do a direct providermembership for, for every day to day,
you know, the earinfections, the preventative,
the annual wellnessthat could be for that.
There are also providers that arethere's also programs
(25:50):
where you can do that virtually nowand you just pay a monthly fee,
and it covers all their day to day stuffas well as well as prescription.
But then we can also offer what we callcatastrophic plans,
where if somebody gets diagnosedwith a major medical condition,
then you have the catastrophic coveragethat can also help cover that.
(26:12):
There's HRA where, employers can pay
for first dollar coverage,or they can pay for the back end coverage.
There's a HSA accountwe've heard, actually.
Now people are
very much a proponent of HSA
where they're saving 20 to $30,000already to
(26:32):
cover their medical expenses.
There is GigCare to helpwith the solutions?
There's level funded.
Most companiesnow are trying to get away from the ACA
because they are they are age rated.
Are they are set
And you're goingto see your employers that
(26:55):
when you've got reasonably healthy groupsare going to start looking for a way out.
That's right.
They want to get off.
They wantthey've got to find something that works.
This thing is not sustainablethe way it is now.
But as a broker you have to be willingto step outside the box.
Yet be willing to listento what somebody is dealing with.
How do I solve the problem.
(27:15):
And here's the set of solutions.
There's so many solutions we can
implement.
You know, we've done a gap planto help with the larger,
high deductible health plans where we addthat as a plan for our clients.
And that helps cover the gap betweenthe deductible between the two plans.
(27:38):
There's just a lot of creative solutions.
We just need to know what your needs are,what your pain points
are, and let's get togetherand figure out the different options.
Here's the thing, okay?
You have to be,you've got to be proactive here.
Don't wait until you knowrenewal hits you with a 25% increase.
(27:58):
Or a 29% increase from Medica or Celticor one of the other ones.
Okay, now's the time to act.
Start a consultation,give them a call, get ahold of Maria.
Get Ahold of Carolee.
877-385-2224.
It doesn't cost you anythingto talk to these folks, okay?
And they can help you get a solution.
(28:20):
That's going to make sense, butyou have to get in front of it, not do it.
At the end of the situationwhere now you've got to renewal
and you don't have any timeto make a decent decision.
So once again, 877-385-2224
or their websiteRPSBenefitsbyDesignInc.com.
rpsbenefitsbydesigninc.com.
When I come back we're going to explainHSAs so you understand how they work
(28:43):
and these HRAs and how you can incorporatethose and keep benefits
for a major network, but have that benefitif you have a catastrophic illness.
Stay tuned.We'll be right back after the break.
You're listening to America'sHealthcare Advocate
Broadcasting here on the HIARadio Network.
Coast to coast across the USA.
(29:09):
Welcome back.
You're listening to America's HealthcareAdvocate show, broadcasting coast
to coast across the USA here on the HIARadio Network.
My producer, Mr. Garner Cowdery,behind the microphone.
Dave Thiessen behind all the cameras.
Putting all this together.
For all of you out there in our audience,on our podcast channels, YouTube
channels, and across the airon all of our terrestrial radio stations.
(29:29):
In studio with me, Carolee Steele andMaria Ahlers from RPS Benefits by Design.
We're telling you, get prepared.
It's coming. It's going to be a tsunami.
It's coming.
Don'twait until you're caught up in it, okay?
These people can helpyou navigate through.
The sky is not falling.
It's not the end of the world, okay?
But you've got to prepare yourselfand if you're the employer, for God's
(29:53):
sake, pick up the phoneand give these folks a call.
If you're an individualand you're concerned
and maybe you're one of those Aetnapeople, you're losing coverage altogether.
Okay, well, give them a call.
They're happy to help.
877-385-2224 they are experts.
They do this nationally.
Okay?
877-385-2224
(30:13):
or the website rpsbenefitsbydesigninc.com.
You know, HSAs were introducedI don't know was it 15 years ago?
Something like that.
And it was a hard conceptfor people to grasp.
Correct.
But when you look at how they functionversus how
what I call the American Express Plan,where you have your American Express card,
you don't have to you walk inand make a $10 co-pay and you're done.
(30:36):
Well, those days are gone.
Yeah, that's why the premiumsare going through the roof.
Let's talk about how the HSA works,why is it beneficial
and why are a lot of peoplemoving to those plans?
Well, I think it’s wonderful.I have an HSA.
So what HSA is, is thatyou can put monies away
every year toward, it's a certain amountdepending on if you are single.
(30:59):
It’s up to $6,300 a year.
Or a family, you can put that away.
It's typically you've got to,
everything comes out of pocketuntil you meet that deductible.
And then there's a percentagefor insurance.
Typically the
employer offers an HSA that
is a reduced premium compared to the otherstandard traditional plans.
(31:20):
So that was one good.
It also, you can use that money.
It rolls over to the following year.
So it's not a use it or lose itat the end of the year.
Correct, it's not a flex spending account.
It is an HSA account. Yes.
And this is really wonderfulbecause if you have a family,
your daughter needs to have her
teeth pulled to get something for wisdomteeth pulled.
(31:42):
You can use that as long as they're taxdependents in the family.
You can usethose HSA funds toward that as well.
And here's the thing.
When you put the money in there,it's a tax deduction.
Right.
So if you put $6,300 in there you justtook $6,300 off of your tax liability.
Correct. It's a tax deduction.
That's huge. And Maria, once you hit a.
(32:04):
Certain amount you can invest that moneyin the money market.
I didn't know that. You can.
So there's another option. Yeah.
So the money stacks up.
You get pastyour first year, you've got enough
to cover the deductible coinsurancetypically down the road.
Okay.
As you continue to add to it, you'rebuilding an account.
(32:25):
And as you said you can invest that moneyMaria.
So this is an opportunity individual side.
So tax deductible going in tax freecoming out.
You can use it for more than health care.
You can use it for dental.
You can use it to buy glasses.
You can use itfor a host of different things right.
You get a debit card.You have an HSA account.
That's how it works.
How does this work for employers?
(32:45):
Now, Maria, in terms of you talked in thelast segment, if you drop premiums 30%,
the employer can afford to say,
you know what, if you got an HSA, I'mgoing to go ahead and add another $100
a month to this for your HSA accountto encourage people do it.
Does that make sense?
There's a lot of different strategies,Cary, that we work with our clients.
(33:07):
We have clients where they do, a highdeductible health plan, offer an HSA,
and then they contribute 100%to the employee's HSA to help
with their costs up to their deductible.
We have clients that will, embed an HRA,
which where they'll cover again,if your deductible is $3,000,
(33:29):
that employer will cover, will decidethey'll cover the first,
maybe the first 1500 of your deductible,or they'll cover the back
1500 of your deductible.
But these are creative strategiesthat we work with our clients
to make it work for them, but yet
provide them with comprehensivecoverage for their employees.
(33:49):
So yeah, there'sthere's it's it's all about strategy.
And I think the point that you madeearlier is we need to start on it
proactively.
Most employers will waituntil they get their renewal.
Well then we only got 60 days.
And with that 60 dayswe have to strategize,
look at different options, go to market,look at the financial analysis.
(34:12):
The other piece to this that some of ourclients don't, recognize that we've,
put into play a lot is critical illnessand accident and hospital indemnity.
Those lines of coveragehelp with the medical costs as well.
So there are ways to blend those in.
And therethose are relatively inexpensive.
Relatively inexpensive.
I had a cancer plan forI don't know how many years it was.
(34:35):
I had a bulk cancer plan of $50,000,
and the way it worked was, I hate Aflac,just so we all know I like ducks.
I prefer it with orange sauce. Yes, but
you know, I don't like the Aflac modelbecause what they do
is you have to send in your claimsand then they reimburse you.
The model that I had was onceI was diagnosed
(34:56):
with cancer, and the actual diagnosiswent into the carrier.
I got a check three days later, period.
And you can spend it
on whatever you like.
Whatever I wanted.
If wanted to go sit
on a beach in Mexico and decide, okay,this is where I'm going to finish it up.
That's right.
I've got terminal cancer.
That was my money to do what I want with.
But that was a very inexpensive policy.
(35:18):
But it gave me peace of mind.
Because we know bills don't stopjust because you're in the hospital. No.
And to piggyback on that, asfar as having your, like a critical, like,
cancer, stroke and heart, you may haveyou may have a Medicare supplement.
So you don't have
a lot of medical out-of-pocket,but you may have to go to Mayo Clinic,
and you're goingto have to stay in a hotel,
(35:38):
and you're going to have to fly there,and you're going to have to do all that.
So that is also used.
That money can be used forthat as well. Yeah.
So I think what we're trying to say hereis we're wrapping this up today.
And thank you both to meand Maria and Carolee.
You know, it'sgreat to have experts in studio
that can really walk youthrough this stuff.
It's complicated,but this is why I do these broadcasts.
(35:58):
And I bring people on here that canexplain this to make sense out of it.
So you're looking for a solution?
You heard Maria just say this.
Here's what happens.
Everybody waitsuntil those renewal notices
hit or ACA open enrollment startsand then they start calling.
Well, you're not the only one okay.
You know. Yeah.The phones are melting down.
(36:19):
I remember doing this backwhen I ran Benefits by Design.
And literallythe phones would be melting down
with people in a panictrying to get this done.
This year's going to be worse.
That'swhy I'm doing this show way ahead of time.
Okay.
So you know that it's coming.
And prepare yourself.
If you're an individual, you need help.
Get ahold of Carolee, 877-385-2224.
(36:42):
If you're an employer, you just heardMaria walk through how they do this.
They do a full blown analysis.
This is a come in and laya spreadsheet down.
They comein, they do a full blown analysis,
come back to youwith a series of solutions,
and then you pickthe one you think makes the most sense.
That's what I'm suggesting you do.
877-385-2224 is their phone number.
(37:03):
Their websiteis rpsbenefitsbydesigninc.com.
If you are one of the folksthat are facing these kinds of renewals
and what's happening,now's the time to reach out to them.
And now I leave youwith this thought from Albert Einstein,
the one who follows the crowd theyusually get no further than the crowd.
The one who walks alone will likely findhimself in places no one has ever been.
(37:24):
Remember,friends it’s a funny thing about life,
if you refuse to accept anythingbut the very best, you most often get it.
Thank you for listening to America'sHealthcare Advocate Show,
broadcasting coast to coast across the USAhere on the HIA Radio Network.
Goodbye America.
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