News and Blog



Monday, 20 November 2017

While President Trump continues to try and unwind parts of the Affordable Care Act, the IRS is starting to chase down companies failing to offer affordable coverage to their employees. Beginning with companies over 100 employees the IRS is asking for proof these companies are providing qualified and affordable insurance or they will be forced to pay up. 

The IRS has had multiple problems enforcing the mandate due to lack of funding and computer problems. In the tests they have run, most reports are inaccurate and are expected to create much back and forth discussion with companies who are in full compliance of the ACA rules. The Kaiser Family Foundation estimates 8% of small employers (50 - 100 employees) are not in compliance. This first wave of enforcement and letters is targeting companies with more than 100 employees. 

As a group insurance consultant, one of the biggest challenges we see is the 30 hour mandate for full time eligibility and the fact that "affordable" premiums are based on a 30 hour workweek. This is one rule we hope the current administration will correct. There are many problems but this seems an easy fix thought it will open up millions of additional part-time employees to Obamacare subsidies. 

Read more here

Posted on 11/20/2017 8:18 AM by David Moore
Thursday, 12 October 2017

President Trump signed an executive order today to trying to change the way health insurance is regulated, designed, governed and purchased. His plan covers three main areas hoping to spur competition, reduce regulations and lower health insurance costs for millions of Americans.

Selling Health Insurance Across State Lines

Trumps first act will allow insurance companies to sell health insurance policies across state lines. This has been attempted for years and will be the first true test if insurance companies are willing to try. Until now, each state has their own insurance department that makes specific rules to govern their state. This will presumably allow a carrier to set up a policy in one state and sell it across the country using the home states rules and regulations. It also allows the carriers to exclude some of the ACA protections that have increased costs for the healthier population while benefiting those with pre-existing conditions. Will it work, see the attached article from Milliman discussing the intended and untended consequences. There are many things that can go wrong but hopefully it will create options and more competition. This will be a challenge for regional carriers like BlueCross Blue Shield of Tennessee as they don't have national PPO networks like Cigna, Aetna or United HealthCare. 

Association Health Plans

This is another program that has been discussed for more than 20 years. There have been several examples during my career but each time they crash and burn as those who can get coverage cheaper leave the association plan to set up their own. This creates a less and less healthy group increasing premiums and ultimately failing. I do believe this will result in numerous options for small business owners and now it appears individuals will be able to sign up as well. More options, which is something thing we have not had for many years. My fingers are crossed because we need help to create competition and bring down costs. Again, because they will not have to comply with many of the rigorous ACA laws of community rating, no pre-existing conditions and other mandates, there will be winners and losers.

Short-term policies

The ACA strictly limited how long an individual could keep a short term health insurance policy and what they were required to cover. These were affordable options for those in between jobs, just out of school or looking for an affordable health care option.  That all went away and it would be nice to see “good” short term coverage return as an option for those in specific circumstances. Not intended to replace a normal individual or group policy they do serve a purpose in keeping people insured.

Posted on 10/12/2017 2:34 PM by David Moore
Monday, 11 September 2017

Level Funded health insurance for the small and mid-sized group market.

As rates, requirements and ACA taxes continue, the insurance carriers have created health plans to help employers find affordable options for their employees. One that has proven most successful is a level funding strategy blends the simplicity and protection of a fully insured plan with the flexibility, ACA avoidance and opportunity to share in claims experience gains of a self-insured health plan.  

The success of a plan like this for your company begins with underwriting, if you are a healthy group with good claims experience you may be able to save a lot of money. For groups with under 50 employees you are subject to community rating and ACAs limited plan designs. Community rating means everyone pays the same rates regardless of your group’s health, male/female ratios and type of industry. For larger groups, while you are underwritten on these factors, you are still pooled with many other groups and if you have a good claims year there are no refunds for overpaying for your coverage.

Level Funded health plans give you the protection of a fully insured premium meaning that is the most you can pay regardless of your claims experience. The big difference is premiums are broken into fixed costs (administration and reinsurance) and claims costs (money to pay your claims). The claims funding is where you can receive money back if your claims come in less than expected. In the event of a bad claims year you can expect an increase in rates just like you would in the fully insured world. The difference is, most of that increase will be going into the claims funding bucket and in the next year if claims return to normal, you will get some of that increase in premiums back.

Another big difference is the ability for small groups (under 50 employees) to have flexibility to build plan designs to meet their needs rather than to meet the ACAs rigid bronze, silver, gold & platinum requirements.

Sound too good to be true? For many it will be because you have to go through underwriting to qualify. If the carrier is going to give you money back in good claims years and eat the losses in bad years they want to make sure and work with healthy groups. Fortunately, it has gotten easier to get your employees through underwriting with the simplified Milliman Rx reporting. Carriers can now order data about your employee’s prescription usage and are making underwriting decisions based on that rather than having all your employees fill out health statements.

Who are these new plans designed for? We can now get quotes down to 10 enrolled employees. Not all carriers are going this low and most want 25 enrolled. Regardless, there are new options for you to consider and we would like to show you how it works and if this is a good fit for your company.

Please call David Moore at 615-724-1699 or email for more information and to get pricing options for your company.

Posted on 09/11/2017 10:24 AM by David Moore
Friday, 08 September 2017

Hello everyone,

As part of our ongoing efforts to help keep your personal information as safe as possible, we want to remind you to stay on the lookout for the many security threats making the rounds in cyberspace today.

Recently, we learned about a massive Equifax breach in which more than 143 million consumers may have had their information compromised, including:

  • Social security numbers
  • Dates of birth
  • Addresses
  • Driver’s license numbers
  • Credit card information (for approximately 209,000 consumers)

Due to the high potential impact of this breach, we recommend taking the following steps:

1) Determine whether you may have been affected. Through Equifax’s self-service portal, you can quickly determine whether your information may have been compromised. Enter your last name and the last six digits of your social security number, and you’ll find out whether Equifax believes you’ve been affected. This process takes only a couple of minutes.

2) Enroll in Equifax’s credit monitoring and identity theft protection. Equifax is now offering one free year of TrustedID Premier, its credit monitoring and identity theft protection product, to all U.S. consumers, even if you aren’t a victim.

Once you enter your information in Equifax’s self-service portal, you’ll be given the option to enroll in TrustedID Premier. Click Enroll, and you’ll be provided with an enrollment date. Be sure to write down this date and return to the site on or after that date.

3) Be wary of e-mails that come from Equifax. Because of the high number of victims, Equifax is notifying only the 209,000 consumers whose credit card information may have been affected via postal mail. Do not trust e-mails that appear to come from Equifax regarding the breach. Attackers are likely to take advantage of the situation and craft sophisticated phishing e-mails.

4) Monitor your accounts for suspicious activity. Equifax’s free TrustedID Premier service can help you monitor your credit—but be sure to monitor your other important accounts for any suspicious activity.

For more information, visit Equifax’s FAQs page regarding the incident.

Rest assured that we are always concerned about information security. 

Posted on 09/08/2017 3:58 PM by David Moore
Thursday, 31 August 2017

There is good news for small groups looking for insurance options in 2018. Humana recently announced their partnership with health insurance start up Oscar. Oscar is not new to health insurance, they have been selling policies in Texas, California and New York for many years, now it's time to branch. The easiest way to do that is partner with a larger company in the market you are interested in.

Welcome Humana. Humana has long been a friend to small businesses with their employee benefit programs but recently they have had a hard time getting good provider contracts in middle Tn. The fresh approach Oscar brings is changing that as hospitals are once again welcoming Humana in with new and better contracts. That means better pricing and good provider networks for you as a member and your employees. 

Oscar brings technology, wellness and easy, affordable access to care. By embracing technology and customer service they are giving members the tools they need to find answers and access to care at their fingertips. 

We will start quoting their plans in early October. We would love to talk with you about your employee benefits and show you how the Humana/Oscar partnership can help bring down your healthcare costs. 

Learn more here

David Moore 615-724-1698


Posted on 08/31/2017 3:25 PM by David Moore
Tuesday, 01 August 2017

Middle Tennesseans just lost the last good ACA compliant health insurance option for 2018. Farm Bureau offered health insurance with a PPO network that included all the major hospitals across the state, that option will not be available in 2018. Those needing individual health insurance in 2018 are going to find their options very slim and expensive. Here is a good article written by Alex Tolbert that shares light on the subject and discusses the few options remaining. 

Tennessean article

Unfortunately the carriers have exclude brokers from helping individuals find quality insurance options. We hope there are changes for the positive coming in the near future and will keep you posted as we learn more. 

Posted on 08/01/2017 11:08 AM by David Moore
Friday, 14 July 2017

After a very frustrating, strenuous and divisive attempt to overturn ObamaCare, the carriers had to make decisions and get plans and pricing ready for 2018. There are several big unknown factors that could significantly affect carriers, plans, pricing and consumers in the individual and subsidized markets. Will congress approve benefit subsidies, premium subsidies and/or do away with the Shared Responsibility Payments or penalties for not having qualified health insurance? Since we don't know the final answer, carriers are assuming the worst and pricing these changes into thier policies.

Carriers are finally releasing their "requested" rate increases for 2018. In Tennessee, Cigna is asking for a 42.1 percent average increase, while Blue Cross/Blue Shield wants a 21.4 percent increase. While those numbers are down from 2017 (Blue Cross/Blue Shield asked for and was granted a 62 percent increase last year), the marketplace is still unstable, according to Rep. Marsha Blackburn (R-TN), who represents the state's 7th congressional district.

She said it’s "no secret the individual marketplace is collapsing."

"It’s no longer a question of if it will fail, but when it will fail completely," Blackburn told Patient Daily. "These provisional increases are the latest in a long line of examples of why we need to repeal the ACA and address the real cost-drivers of health care and coverage."

"Coverage under the ACA is already unusable for far too many due to sky-high deductibles, premiums or never-ending co-pays." said the Congresswoman. "Now, I fear premiums will continue to rise until Americans are simply forced out of the market."

Insurers said that when they were requesting premium rates, they factored in uncertainty, particularly over cost sharing subsidies and whether the individual mandate will remain in place, the repeal of which could lead to more healthy people leaving the marketplace. However, they also cited increased medical costs and rising drug prices as a reason for the high premium requests.

The deadline for insurers to file their initial rate requests for 2018 was June 21. More rate requests from states may be made public throughout the rest of summer and into fall. However, final rates won’t likely be announced until later in the year.

It is important to note that BCBST is picking up the slack in Knoxville where Humana pulled out leaving no carriers to provide insurance to those residents. This will be the only major market where BCBST is offering individual policies. 

Posted on 07/14/2017 12:10 PM by David Moore
Thursday, 13 July 2017

The cost of prescriptions is the fastest rising cost in healthcare today. Cigna estimates annual trend at over 15% with no sign of slowing down. There are several reasons this is happening: direct to consumer advertising, specialty drugs that were not available in the past, extreme price increases from the manufacturers and lack of knowing your options. 

Just speaking from personal experience when a doctor prescribes a medicine for a specific condition, I generally don't question that decision. Or at least I didn't in the past. The problem I am beginning to understand is doctors have no idea what one medicine costs vs. another and a drug representative is only telling why their medicine is the best. The truth is, for many medical conditions there are numerous different medications that will effectively treat the condition for prices that vary greatly. 

How do you find out what options there are and at what cost?

This is what has helped me and many of our clients - GoodRx is a website with not only great information about every medication, it will show you actual costs from drug stores in your area. A disclaimer here is these prices will be different based on your insurance plan but it will give you a very good idea. 

Coupons, there are many coupons that you can use even if you have health insurance. This will save you real money. 

Knowing the cost of the medicine before you leave the doctors office. GoodRx has an app you can download to your smartphone to see the cost of the medicines the doctor is prescribing for you so you can ask "is there another medicine I can use that does not cost as much?"  I have done this on many occasions and have never had a doctor not try to save me money. 

Another great use of this app is to lookup the cost of the medicines continually advertised on TV. This will give you a much better understanding of why health insurance costs so much. This advertising works! Doctors don't have time to educate you about why an older, lower cost Medlicine will be as effective for you. Unfortunately, it's easier to let you try this new, latest, greatest and very expensive medicine rather than risk losing a patient. 

Increasing prescription costs is a real problem in the cost of health insurance today. By becoming aware and shopping smartly we can all make a difference. 

Thanks for reading, have a great day!


Posted on 07/13/2017 3:38 PM by David Moore
Monday, 08 May 2017

The Tennessean ran a great story written by Sherri Zink the Chief Data Officer for BCBST this weekend. A few takeaways I think you will be interested in are" 

  • In 2016 BCBST paid out $13.9 Billion for health care services
  • This covered care for 3,4 million members for an average cost of $4,088 each
  • Costs were 8.4% higher in 2016 than they were in 2015
  • Pharmacy costs have increased by 81% from 2013 to 2016
  • In 2016, half of all medical costs were attributed to 25% of the members who were treated for cancer or one of five chronic conditions (diabetes, cardiovascular disease, asthma, COPD or congestive heart failure

What is BlueCross BlueShield of TN doing to combat this trend and try to control costs? First is the direct negotiation with providers and working to shift payment methods to reward better health outcomes. Many complain when the "newest" prescription they ask for is denied but this is an out of control cost and in many cases this "new medicine is no better than the old one for a patient, it only costs 10x more. BCBST is working harder to to stay in touch with those who have chronic conditions to ensure they are getting the care they need and are compliant on medications. 

To read the entire story click here 

Posted on 05/08/2017 1:06 PM by David Moore
Thursday, 13 April 2017

We are getting a lot of questions about the end of Obamacare and “when will my premiums go down?” There have been many changes to our individual and small group health insurance plans over the past five years. The Trump administration has spoken loud and clear that they want to do away with Obamacare, we can already see it won’t be quite that easy. We do expect several changes over the next 12 months but overall we think many of the current provisions will continue.

Trumps healthcare agenda

We don’t expect a full repeal of Obamacare but there are a number of changes we think will happen over the coming year.

  • Allowing carriers to sell insurance across state lines
  • Association health plans and an expansion of self-insured small group plans
  • Delay the Cadillac Tax until 2026
  • Eliminate employer shared responsibility penalties
  • Allow individuals to use subsidy dollars for any health plan
  • Increase HSA contributions to nearly double the current limits

What won’t change even if Trump gets his way?

  • Pre-existing condition exclusion
  • Ability to cover children to age 26
  • Preventive services covered at 100%
  • No annual or lifetime limits
  • Limits on out of pocket maximums for large claims

There are also a few things that could go either way

  • Limiting the pre-tax treatment of employee deductions for medical and dental plans
  • Allowing tax deductions for individual policies
  • Allowing employers to pay for individual policies with deductible dollars
  • Allowing states to made decisions about Essential Health Benefits

You can see, there are a lot of moving parts and with every change there are winners and losers. What we do know is right now is it’s business as usual and you must continue to comply with the current rules. Carriers are making decisions right now about what types of policies they will offer in 2018 and who they will offer them to. Without a clear direction from the current administration we fear most will find it easier to walk away than continue to lose money in the individual market.

It’s important to understand that most of the pain is in the individual market. This is where the huge premium and benefit subsidies are being paid and the lack of enrollment, eligibility and guarantee issues rules have made it all but impossible for insurance carriers to manage claims and losses. Here in Tennessee we have been BlueCross BlueShield of TN pull out of the large markets leaving in many cases just one carrier for people to choose from. As of today, Knoxville and the surrounding counties will not have any insurance companies to choose from leaving them unable to get any coverage at all. Hopefully another carrier will fill the void but at what cost?

Posted on 04/13/2017 2:48 PM by David Moore