Rethink Healthcare Together Ep 01

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Episode Transcript

(00:03):
Hi, Ryan Thomas here with JohnRoman covers since he with our first episode
of Rethink Healthcare Together. John,is a pleasure to have you in studio
to talk about the wonderful service you'reproviding for my listeners and others, helping
them get what I find hard tobelieve affordable medical insurance. Good to talk
to you. I really appreciate gettinga chance to come in here and finally
meet you. Brian. Well,you're going to explain a different way to

(00:24):
get insurance. I know it's opento rollment season right now, and everybody's
like immediately defaults of their employer orthe immediately default to Obamacare. I don't
have any choices in this. Geez, look at what my deductiles and my
copas are going to be. Myemployer isn't offering me any real choices here.
That's I mean, that may bepeople's perception, but is nowhere near
what reality is. You are amedical insurance broker and you work on behalf

(00:46):
of people looking for the best medicalcovers, like a fiduciary obligation. Absolutely,
so you know, our main goaleach and every time that we talk
to a client is to really understandtheir situation. Every person comes with a
completely unique situation to us, andwe pride ourselves on getting to the bottom
of what makes the most sense forthem. You know, high deductible health

(01:07):
plans don't make sense for every singleperson out there. And you see these
huge added pocket expenses, especially inthe marketplace. They're going over nineteen thousand
dollars out of pocket for a familyfor twenty twenty four. I mean,
most families don't have that type offunds sitting aside. They go pay nineteen
grand. Oh my god, Ihad to use my health insurance this year.
On top of the fact, theyhave to pay the premium. So
if you're paying a thousand bucks amonth for health insurance policy, you have

(01:30):
to add that plus the fact thatyou're on the hook for nineteen grand,
you're talking about almost thirty thousand dollarsin financial exposure on a one year basis,
if not more, if you're ata network. You know, it
doesn't even sound hard to believe thatthat is the case, because that's not
really insurance. I mean, atthe end of the day, what are
the insurance companies really looking for?They want to protect you from a large

(01:52):
claim, But we know that's likeseventy percent of claims are going to be
undred twenty grand, So really they'reon a thirty percent exposure of everybody really
having to pay at those large claims. So most people get nickeled in dime.
And you know the funny thing,Brian, I follow these all these
social media things out there, likeTikTok, and there's one of the things
I followed is literally it's insurance sucks, and it's all these people all they

(02:13):
do is talk about how bad theirinsurance is. Yeah, because they go,
I pay for something, and thenevery time I use it, now
I'm getting Now I get bills.Now I'm paying even more. What's the
point of having health insurance if allI do is keep paying more out of
pocket? Well, and I canunderstand the argument for let's say someone like
my son who is insured through you, and thank you so much, what
a great experience he had. Hecouldn't believe the low premium and the coverage

(02:37):
he's got. It's worked out wonderfullyfor him. But he's young and he's
healthy. So for someone like him, a catastrophic policy could make great sense
because he's not going to be goingto the doctor very much. He doesn't
have any chronic illnesses, and ifthat big thing happens, he's in an
accident, God forbid he ends upin the hospital, that's when your coverage
can kick in in earnest. Absolutely, But that's not for everybody though,

(02:57):
Well, but it's for everybody onepoint. Purpose number one, you have
to protect the top end, rightno matter what you do, period,
Does it make any sense at allto buy a health insurance policy has not
got to protect you from a majorclaim. But even someone like your son,
you know, if he's not ona huge income on a monthly basis,
that will be even a couple thousanddollars a couple thousand dollars out of
pocket could destroy him financially. Imean, most people live paycheck to paycheck.

(03:21):
So imagine going to the hospital havinga you know, two or three
thousand dollars a little out of pocketbill. Well, if you don't have
coverage for that, you're paying thatbill. How do you come up with
that money? Well, and Ido commercials for affordable imaging services. You
know, they always point out it'slike three thousand dollars for CT scan and
you got one of these policies,that's your money it is coming out of
your bank account. That's a lot, and that's a big hit even for

(03:44):
people who are you know, betteror off. No one wants to write
a check like that. I mean, that's the point of insurance. So
it covers Sincy, which I willlet people folks know it's cover Sincy with
Y or I coversincy dot com andget all the information A plus with a
better business bureau. How many yearshave you been at this? You're an
insurance broker, which the distinction isthat we're going the point we're ultimately getting
through here is you work on behalfof your client and you have access to

(04:05):
a couple of hundred insurance companies,which gives you flexibility, oh in thousands
of plans. So I mean it'snot just one hundred insurance companies, it's
each one has ten, fifteen,twenty different options. So you know that's
what we have to navigate. Butyou know that's why we're the experts.
I mean, you mentioned how longI've been doing this. I mean it's
going on nineteen years now, youknow, so I've been here, you

(04:27):
know, way before Obamacare, ACAmarketplace. You know, I saw the
landscape, you know, Back then, it was easier. You know,
if if you could qualify medically,if you're younger and have any health issues,
you could pick up an affordable healthplan, maybe have one thousand dollars
deductible fifteen hundred or something like that, and it wasn't that expensive. But
now what you're seeing in the marketplaceis, you know, when you make

(04:47):
a decision and say, hey,there's there's no way to stop people to
get into the pool, right soyou're just going to say, hey,
we we'll take everybody like the marketplacedoes. Right now. That's where you
get these high risk premiums because youknow, you could have cancer right now
and sign up today and January first, your plan will start and cover that

(05:08):
pre existing condition that you have rightnow, so there's no you know,
you understand how insurance works. Ido you have risk that's an adverse risk
selection? Yeah, I know.He listen. When they got rid of
preexisting condition exclusion, I always said, well, that doesn't make any sense.
Why would I buy insurance If Ican buy it after the risk the
cancer is manifested itself. I've savedmyself all that premium and I'm not penalized

(05:29):
for not planning ahead. It's likebuying you know, homeowner's insurance after the
fire already got started, or acar insurance after you smack the tree.
Yeah all right, so that andthat makes us if you're talking about underwriting
here, Yes, so a reasonablyhealthy person comes into you and that premium
is going to be lower because oh, they're reasonably healthy. Right. Oh
yeah, So just kind of goingback to what we're seeing right now,

(05:49):
because you know, listen, we'reall being pushed to go into the marketplace
right we're seeing where we'll start seeingads right now on television, you'll see
them on online. I need Googlehealth insurance, I mean healthcare dot gobs
one of the top ones. They'regoing to pull up there. So they're
driving the business to get into thatpool of people at that point. So
what you have to realize is there'sstill alternatives. There's still private health insurance

(06:13):
plans out there. And I'm notsaying you have to be the healthiest person.
I've never seen a doctor in tenyears to be able to qualify.
But if you're reasonably healthy, youknow you're not on some two thousand dollars
a month medication or planning on havinga surgery next month. You can actually
qualify for private health plans, andyou can look and see what those options
do, and because they're medically underwritten, Brian, they can be forty to
sixty percent cheaper than the full priceof a marketplace plan, John Roll mccover

(06:38):
since you dot com, The Obamacarepolicies were sort of this one size fits
all. I'm a guy, let'ssay I was a single guy. I
don't need insurance for let's say pregnancyor risks associated with pregnancy. I don't
need mimographies, at least I don'tthink I do. All of those things.
Though, when you buy an Obamacareplan are in there. It's part
of the coverage. Can you tailora policy that meets the specific needs of

(07:00):
the person in front of you,that doesn't have all those extra bells and
whistles that must be paid for?Oh? Absolutely, So what you're what
you're talking about is minimum essential coverage, right, So, anytime you buy
a plan through the marketplace, ithas to carry those minimum coverage options.
So even if your husband and wifeand you're fifty five years old, you're
carrying maternity coverage, you're carrying childrendental, right, Yeah, so I

(07:23):
mean you're paying into that pool ofthings that you're not actually using. You're
covering contraceptives, medication. I mean, you're not going to use that at
fifty five years old. It doesn'treally make sense. So, really,
what you have to look at ifyou're in a situation where you really find
that you're paying, maybe not gettingmuch of a tax credit, you're paying
almost full price for a marketplace andagain you're relatively healthy, you need to

(07:44):
look at the alternatives. Because oneof the big things, and you know
we'll talk about this later on theshow too, but one of the things
that we'll talk about is just reallywhat does the marketplace mean? I mean,
if you look here in a Cincinnatiarea, right, most of those
plans are HMOs. So if Ihave a plan, give it example,
you know, any of the marketplacespangel looking at in Cincinnati, my coverage
is gonna be Cincinnati. So ifI take a trip and go to Dayton

(08:07):
or even down to Kentucky, chancesare I'm at a network and at HMO,
you have now at a network coverageunless the insurance company deems it a
life threatening emergency. And I saylife threatening. So if you go down
there, you're like, hey,I got shorter breath. I need to
go to the emergency room, andyou know, you're two hundred miles from
your house, and they go,oh, I'm sorry, you have bronchitis.

(08:28):
Well, that's not considered a medicalemergency on my word. So now
you run up a ten twelve thousanddollars emergency room bill and your sol so
that would apply even like for abroken arm. Right, that's not life
threatening, isn't it. I mean, technically, I mean, I'm sure
that they can make an argument,though, I mean it puts you in
a tenuous situation, like, geez, should I really go to the hospital?

(08:48):
This is coming out of my pocket? Maybe I'll just wait and that
shortness of breath turns out to bea major grabber and you expire at home
or expire out on the road.I mean, I may be painting an
absurd example, but listen, ifyou don't have a whole lot of money
in the bank, and you know, because step and foot in the hospital
is going to set you back fourfigures, probably five, but at least

(09:09):
four, there's gonna be some hesitancyon the part of a person who doesn't
have an extra pet of bank accountand maybe even go one in. I
would argue, and isn't it theworst decision to make? Like actually sitting
there thinking about, well, thisis my health, but I have to
make a financial decision. Is thisworth me O getting treatment? It's insurd
I hear it all the time.I mean, especially with like families with

(09:30):
kids, right, I mean Ifell into this situation. I remember my
son was four years old and hehad a lemonade stand out front of her
house, and he's sitting in oneof those you know, accordion style chairs,
you know, a real little chairto the ground, and he falls
over right and hurts his arm.So my wife calls me. She goes,
John, you need to come home. I think his arm's broken.
So I walked through the house andshe's like, well, he was sitting

(09:52):
in this chair. He fell twofeet on his arm, Like you know,
there's no way you broke your armuddHey, come on, I mean
these hold his arms crimes, Likedoes this hurt? Does this hurt?
I'm sending thinking to myself, whyam I even asking these questions? I
should just go and find out ifanything is going on. But you start
making that financial decision because like,well, if I got an emergency,
I'm not only gonna waste three orfour hours of my time. But what
happens I find out with just asprain. Now I got a couple thousand

(10:15):
dollars bill because I have a highdoductible health plan. It doesn't make sense
we should not be making decisions financiallybecause we're a little scared of the bill
on our healthcare. Talking with Johnroman Cover, since he dot commentary,
you find more information on these plans, he can help you. I don't
care what state you're hearing us from. He can definitely help you out.
That is not going to be anissue. It's not just Cincinnati, although

(10:37):
you're since a Cincinnati based office.Absolutely, we'reright here in Westchester. But
our big thing is, you know, we have plans in all fifty states,
so even here in Hawaii. Listento this show. We can help
you. Nobody's chimed in from Hawaiiyet, but I'm hopeful because I got
friends all over the country that havebeen chiming in, so it's it's a
nice thing to know that you canhelp them as well. How does the

(10:58):
plan work? I mean, Isort of default mechanism everybody knows. Once
they have their insurance card, theygo to doctor, they hand the insurance
card Somewhere, by some unknown magicalalchemy process behind the scenes, the claim
is processed. Sometimes you get abill from your provider. They haven't processed
the claim yet. I'm staring ata bill for fifteen hundred bucks PA.
I thought I had coverage for this. I thought I met my deductible already.

(11:18):
Well down the road. They mayend up reconciling it, but at
least I know the process. Doesthe process of getting medical care and presenting
the card and having the claim's processwork the same, or is it different
when we work through covers since ewell, it's exactly the same thing.
So anything we're going to tell youis legitimate insurance insurance. You're going to
actually get a card, and it'sall the electronic billing systems like anything else

(11:41):
that we do. I mean,there's hundreds of different insurance companies that don't
operate on the marketplace, and theyall work exactly the same way as your
marketplace plan. You can go inand hand your card. But taking a
step back, I mean you haveto be a good consumer of healthcare too.
I mean I know you've talked aboutimaging things and cheaper prices on your
show, so I mean that's somethingthat we should absolutely do. So,

(12:03):
you know, one of the thingsthat we pride ourselves on when we work
with a client is I'm not justan expert in health insurance. I'm also
an expert in healthcare. So mymain goal is to show you the pitfalls
that you can run into where youwill have financial exposure, like an emergency
room claim, like an MRI.It's probably the number one call in that
we have from clients is like John, doctor just says I need to get

(12:24):
an MRI. I'm in there.They didn't even hand me a prescription.
An hour after I get to thedoctor's office, some schedulers calling me from
the hospital going hey, I'm hereto schedule your MRI for later day or
first thing tomorrow. And then youjust schedule it. I mean, the
simplest question Brian asked somebody much howmuch is a call? I know,
how much does it cost? So, I mean, how do we get
to that place where no one askshow much it's gonna cost. It's the

(12:46):
only business in the world where everybody'sgonna need it. Everybody needs a doctor
at some point, but nobody askedthe dang question, tease, doc,
what's this gonna run me? Becausefor whatever reason, we got into a
mindset that once our doctor speaks,we just listen and we don't ask questions.
I mean, that's the easiest questionto ask, is Doc, how

(13:07):
much is this going to cost?Well? I don't know. Well,
then I'll want to talk to theperson that has that information. So if
it's that scheduler, yeah, Sometimesthey don't even know exactly and they'll call
you back forty five minutes later.Because this happened to me and my son
needed an MRI and they call meback and go, it's thirty eight hundred
dollars. I'm like, okay,well thank you. That's my starting point.
You know, you start calling.I mean the easiest thing Google.

(13:28):
Go to Google like imaging places nearme, and fifty different ones pop up,
and just call the top three.I mean, the doctor can give
you the code and you go,hey, here's my CPT code. This
is what I need to go infor. I mean, we went to
a place locally in Westchester. Itwas four hundred and fifty dollars for the
thirty eight hundred dollars MRI, samemachine, same imaging. They sent it

(13:48):
right to the doctor. I actuallyasked him. I was like, Hey,
was there any difference with this one? He goes, no, look
exactly the same right, And youknow, like, like my client,
affordable imaging services includes the radiologists report. See, it's cheaper. Everything's included.
If you go to the hospital,you not only get that three thousand
plus dollar bill, potentially you alsopay a separate charge for the contrast and
a separate bill for the radiologists.And you're like overwhelmed. This is something

(14:11):
going back to your point on allof this, this is something that people
get with Cover Sincy and you,John Roman and your team before you get
this service, call you and haveyou provide your insured guidance on where you
can get the best medical care forthe best cost. So it's funny that
I've been doing this for nineteen years. I mean, I'd probably say the

(14:33):
first eight nine of them we wouldnever get phone calls because the expenses weren't
as high as they are today.Back then, you'll get thousand dollars out
the well. You don't really thinkabout a thirty hundred ARMRI. But now
that these ductiples are just astronomically expensive. You have to be a good consumer.
So I literally, over the lastsix seven years hired in house people
to help my clients with this becausethere's no bridge between you and the insurance

(14:58):
company. Like who's the gate keeper, who's gonna say stop, this is
not a good decision, you know, for you to do this, or
like what happens if you get thatEOB back, the explanation of benefit back
from the insurance company, and you'relike, you're like a lot of us,
we just pay the doctor bill.It's like the peace of God.
Those things pass all human understanding.That's right, Listen. I even was.
I worked for Anthon, Blue Crustand Blue Shield in the litigation department,

(15:18):
and even I struggle with EOBS.I'm just thankful my wife works from,
you know, the largest healthcare systemand understands all of that, and
she knows whose bells to ring andwhich phone calls to make to rattle cages.
You don't have to be married tomy wife to get this benefit,
because he got it with you aslong as you're insured through cover sensing.
Yeah, I mean that's that's so. That's literally how we had to structure

(15:39):
our business because where I was tiredof hearing clients complaining about things like,
well, this didn't cover this,this didn't cover that. I'm like,
well, know your plan does well. Ninety percent of the time. Providers
building it wrong to the insurance company. They're black and white. They see
a code, they pay a code. If it's wrong, who are you
gonna ask? The doctor? Well, I build it right. The insurance
company, this isn't the right code. The what do you do? You

(16:00):
know? So literally I have myclients call into my care team and they
will analyze the eobs. I'm like, no, this is wrong. Go
back to your provider. Get thisinformation, I mean, and we see
it. I mean, you can'teven have a twelve thousand dollars bill now
without getting bill from like four differentpeople. You know, it's coming from
everywhere and you just don't know.And there are doctors on there you don't

(16:21):
even know. Right, Wait asecond, I was in the hospital for
two days, like eight doctors camein. Every single one of them was
different, and then you're getting allthese different bills and line items from all
these I don't even remember seeing thatperson. But since you're distressed, you're
in the hospital things, it's notyour greatest day of the week. It
kind of blurs over, and sopeople are inclined to just, oh,
I guess I owe the client,but you're saying that you find no,
maybe you don't, Maybe you don't. You know, there's so many unique

(16:45):
and weird situations that we run into. It's we have i would say typically
a different one almost every single everysingle week. We just run into something
new that that happens. And youknow, we're able to research that,
and we have the contacts at theinsurance company that basically say, hey,
you declined to claim. You're sayingit's this, so we're seeing in the
medical records. Is this I needyou to reanalyze that. We've had cases

(17:07):
go a few months that we've gonethe bat for clients and got it overturned
by the insurance company, the endup paying the claimton where layman will never
know even how to start that process. Well, given that it is an
open enrollment season and again my companyis going through right now, I've talked
to a whole bunch of people thatare all going through it. There are
two open enrollments. I got thatright, Yeah, so right now,

(17:30):
Yeah, So right now, weare in two open rollments. We have
the Medicare open enrollment, so youhave the Medicare advantage. If you're in
a situation where you have a Medicareadvantage plan currently or looking to shop around
to find one of those plans thatare out there, that's the open rollment.
You can actually make a change rightnow for January one, if you're
on Medicare and have a prescription plan, which I definitely suggest you do,

(17:53):
otherwise there is a penalty every monthyou don't have one. So if you
need to get a prescription plan,you want to pick up one now during
the open enrollment. Now again thatends December seventh, so you do have
a little bit of time here tostill get that, but I would not
delay on that end. So that'sfor people over sixty five or if you're
on disability and under sixty five andon Medicare and cover since he does help
folks that are dealing with Medicare,absolutely, we say we help you from

(18:17):
birth to death. How many Medicareadvantage variants are there out there? Oh,
there's tons, and every state's different, every area is different. You
can have different plans in each county, so it's kind of it's kind of
more like along the lines I wouldsay, more like the marketplace for the
under sixty five. You know,they're going to typically be more restrictive.
They're going to have networks that you'regoing to have to choose from if you

(18:40):
are going to go into those routes. I always recommend a PPO over an
HMO because HMOs are going to bemore restricted as far as where you go
and where you can actually get youcan get treatment. That's that's the open
enrollment for the Medicare and Medicare,but again you can if you're on a
Medicare supplement, which is what Irecommend for all my clients, that still
gives you access to all doctors andhospitals in the United States, so you're

(19:00):
not restricting your level of care ofwhere you can actually see and that is
open three hundred and sixty five days. So if you are on a Medicare
supplement, your rates are maybe goingup or you want to reshop it or
look at a different plan, youcan do that at any time. The
only time you can make a changeduring this time is if you're on a
Medicare advantage plan. All right,so fixed window for Medicare advantage plan,

(19:22):
get in touch with you and coversince you to find the best available option
or with the sub anytime. Getin touch with you anytime. If you
find out that the benefits are gettingreally expensive. What kind of money we
talk about looking just that the Medicaresupplement plans? What can be the difference
in terms of premiums? How doesthat do the underwrite people? Or I
guess I'm just wondering. Well,there's two windows, right, So when

(19:44):
you turn sixty five here we havesix months before and after that you are
open enrollment into a Medicare supplement.So there's no questions asked medically. Really,
the only question they can ask isif you smoke. That's the only
thing they can actually ding you for. Okay, So if you have medical
issues, if you have ongoing treatment, you can get on a Medicare supplement
at that time. If you waitafter sixty five, then you can fall

(20:06):
into a realm where you have togo underwritten. So Medicare supplements are always
underwritten, so you do have toqualify medically to get into one of those
plans. Now, of course ouroutliers, you know, let's say you
work till seventy and you're still gettingbenefits through your job, and at that
point you retire, that's still anotheropen enrollment at that point, I see.
But from the majority of us attop retire at sixty five, that's

(20:30):
your window. So if you're contemplatingor really trying to see what your options
are, make sure you deal withwhat I would consider a broker that writes
both Medicare supplements and advantage plants,so they can show you the pros and
cons to both well. And that'sthe nice thing about hiving an expert like
you, with all this year's experience, you can you can boil this down
to easily understandable terms and do thecompare and contrast. It's like putting them

(20:52):
all up on a big giant videoscreen and comparing this one offers this,
this one offers this. It's thiscost for this one. But if you
go with that plan, you're goingto suffer because it doesn't carry this.
But if you're over here, it'sjust nice having all that information right in
front of you. Well, theworst part about it, like when you
get closer to sixty five, you'regonna get in daid with mail everybody's gonna
send you something. Every insurance company. You'll have a stack, you know,

(21:15):
twelve inches high on your desk ofall the different brochures from everybody that's
sending to you. And I feellike they almost do that to confuse you
so that you just call somebody likean insurance company that's gonna just put you
in a box. They're gonna say, hey, you called me. I'm
the insurance company. I have threeplans and what I don't care what you're
really looking for. It's gonna beone of those three plans. Well,
what is the downside for you know, people just getting online and just searching

(21:40):
online and filling out forms online.I mean, I know covers since you
can fill a format on your pageand you'll be able to crunch numbers for
them. But you're not gonna behigh pressure and you know, send their
email information out. But that's notalways the case out there in this world
we live in. No, that'smy Everything we do is secure. Everything
that you do and you fill outis confidential just between us. You know,

(22:00):
we are not going to put anyonethat situation. I'm not a lead
generating company. I'm not here togo on my website, you fill out
your information, I'm going to gosend it to ten and ten agents,
and one of them is another leadvendor, and he's going to tell another
ten agents. And now you're gettingthirty different phone calls all across the board.
That does happen all the time,all the time. You know,
we actually had we actually had someonecall us a couple months ago complaining that

(22:21):
they thought they sold their information.I go, well, were you searching
for health insurance before you contact us? Well, yeah, I went on
a couple of websites. I waslike, well, there you go.
I mean, the problem is youtype in health insurance and google that the
first four things that pop up arelead generating companies. That's how agents get
their leads. Pivoting John over tothe other open enrollment Affordable Care Act.
And now, I personally have neverbeen in an Affordable Care Act program,

(22:44):
and I'm not a big fan ofthe fact that it even exists. But
there it is, and many manypeople defall to that. So what's the
story on an Affordable Care Act ascontrast to to let's just say, the
Medicare we're just talking about. Soright now we're in the open enrollment for
the Marketplace So that's runs November firstthrough January fifteenth, So that's the time
that you can make a change ifyou're already on one, or if you're
open to if you've never been onone, that's the time you can actually

(23:07):
buy. So that's the actual openenrollment time frame. Now, outside of
that, like you mentioned, likewhat happens if I get diagnosed cancer in
March, right, Well, yoursol because you would have to wait to
the next open enrollment, which againwould be at the end of the year,
or to get on the plan.Now, there are of course different
situations, right you have what theycall special open enrollments. So like let's
say you move to a different county, or you have a child, or

(23:30):
you get married, or you losecredible coverage. You then would have sixty
days at that point when any timein the year to then get back onto
a marketplace plan. And listen,you know, I come from a standpoint
where I look at every case uniquely, and there are situations where the marketplace
plan does make sense. You know, if you have medical issues and you

(23:51):
know you have to get treatment andyou have to have a surgery, or
you're going through something like cancer.That makes sense if you don't have great
coverage when I find you, I'llmake that reckon. Or if you're in
a situation where you get a lotof tax credit. I mean, you
know, what we saw here recentlywith the COVID relief bill was they took
the top off the tax credits,so now it's expanded way beyond the I

(24:14):
think it was like forty five thousandif you were a single person making forty
five thousand. If you made fortysix thousand, the tax credits went completely
away. So it was like it'slike, how do you keep your income
under one thousand dollars? Right?You know, But now they took that
away. Now it's more a percentage, So we're seeing more people qualify for
tax credits. That makes sense,especially if you're older, at a you
know, mid range income, youmight qualify for a huge tax credit,
and that might make sense in thatsituation. And that's where we come in

(24:38):
too, because even if you're ona marketplace plan, it's just like regular
medicare. There's huge holes, there'shuge gaps, there's all kinds of exposure
that you have financially. Again,at in networks, they ate the nineteen
thousand out of pocket. You know, there's huge things that you can run
into where it's going to be financiallydevastating to you. And so a lot
of times we will package that withall their products and we can actually build

(25:00):
you what I call like a healthcareportfolio of multiple insurance companies that actually work
together to pay your claim. So, yeah, you can supplement a marketplace
plan, really make better coverage.Absolutely, we do it all day,
every day, no kidding. Sothere's covers to fill in the gaps.
That what an interesting concept of that. I never even knew that was possible.

(25:23):
I mean, insurance companies do getsmart. They find an angle.
Well, yeah, they are inthe business of ensuring people. There is
profit modive built into that, sothey see an opportunity and there they are
to fill that hole. So that'swell, I see I learned something every
day as well. John, Right, Well, I'll tell you I don't
know about the cost again of AffordableCare Act plans. Are they really I

(25:47):
mean, clearly the coverage is notstellar. You've got a lot of out
of pocket in connection with those,as we talked about earlier in the show.
You got a lot of coverage thatyou might not even need. But
cost wise, is that an expensivepolicy? I mean a new expensive is
a subjective phrase, but I meanI have a new idea of relativism.
I can only relate it to whatit would look like if you went private.

(26:08):
So in the in the realm ofif you're again going back to that
relatively healthy scale, yeah, right, so if you're relatively healthy, and
if you compare a marketplace plan toa private plan, they're always going to
be about forty percent cheaper on thefull price minimum right across the board.
Wow, again just because there's theylet anybody in. Yeah, so I

(26:30):
call like health and church. Youthink about like an Ingram pool, right,
you know, you want to bein the adult pool or do you
want to be in the kiddie pool? The ACA is a kiddie pool.
There's a lot of stuff happening overthere. Yeah, and you're swimming around
in it, right. Yeah.So you got to be in a situation
where, hey, does this reallymake financial sense to me? You know,
if I'm relatively healthy and I gotto pay full price, I'm not
getting a huge tax credit. Youneed to look at the alternative market because

(26:51):
then it really opens up then you'relooking back at, you know, plans
like we helped your son with wherehe can go to any doctor, any
hospital in the United States. He'snot restricted to Cincinnati if he wants to.
If he gets diagnose a cancer andwants to go down to m D
Anderson and Houston, he can absolutelyjust go and get treatment there. If
you're on a plan here in themarketplace, and Saysinnati, you can't even
leave the area. Well, andagain going back to the mass about of

(27:11):
pocket, I don't even call thatinsurance. It's the complete lack of flexibility.
Is sort of who stays interest intheir own hometown and never goes anywhere.
We're unning a huge risk. Maybeyou argue that you're more likely to
get in problems when you go outof town. Isn't that really the case?
I always feel like something happens whenI'm on a trail easily because it's

(27:33):
like vacation and stuffing. You letyour hair down, Maybe you have an
extra cocktail and the world isn't inperfect place. Screws fall out and you
might slip and fall and injure yourself. Yeah, no coverage for under that
affordable carac plan. No coverage.If you slip and fall and the bill's
eight grand, even nine thousand dollarsultimple, you're paying the whole bill anyway,
so it doesn't really make a difference. It does not make it.
Wow, I've learned a lot todaytalking with you, John Roman covers since

(27:56):
heat dot com is where you findJohn on the team for more affordable insurance
flexibility, And again I love thisidea that you're helping folks navigate the challenges
once they are insured, because youknow, as with my son's plan,
and maybe we can talk about thisin another episode, it works out to
his advantage by finding the most affordableprovider, not sacrificing the quality of medical

(28:18):
expertise. But if you can finda provider that provides a service for a
lot less money, that can insureto your benefit financially as well well.
That the big piece of it,Brian, is to make you the good
consumer. Like we mentioned about biggood healthcare consumer as the pricing, because
if an insurance company says this isexactly what we'll pay for these situations that
you get into, right, thisis the fixed amount that we're gonna pay,

(28:41):
it's up to you to find outif you want to get it if
it's less than that, you know, So if you do good shopping and
you can do it and you finda price less than what they're gonna pay,
the benefit is that the insurance company'son the hook for the entire amount
they're paying. So if there's ayou call it a net benefit, and
you would literally get a check forthe difference of what you shop for.
Yeah, they've established an actuarial amountthey're willing to pay. In my son's

(29:03):
case, on one medical there wasa I think was a a check up.
Yeah, four hundred dollars was theset amount. He got the check
up for about one hundred and twentyfive one hundred and thirty bucks. They
wrote him a check for the difference. It covered his premium and then a
little bit more. Yeah, that'sthe way it works. Great. Yeah,
I'm telling you my son was grinningear to ear. You can listen
to Rethink Healthcare together with John Romanfrom Cover since he find him a line

(29:26):
at cover sinceywire dot com. Youcan fill out a form there to initiate
the process of finding better and lessa more affordable medical coverage, or reach
him at five one three eight hundredtwo two five five at five one three
eight hundred call if you have anyquestions, you know what, why don't
you go ahead and just email John. You can do that anytime. Just
email ask John at coversincy dot com. Ask John at coversincy dot com.

(29:49):
He'll get back with you promptly.Hey, and we can even use your
question on the air, So feelfree to reach out