The Insurance Doctor

Category: Health Insurance

2025 Health Insurance, State of the Union
Are you either unhappy with your agent or unhappy with your current health plan? If yes, keep reading as there are many upcoming 2025 health insurance changes ahead that your agent/broker should be sharing with you!

There are 2 worlds, Traditional (Obamacare) and Non-traditional health insurance! See below what’s in store for most of you with Obama Care traditional insurance group and individual plans for 2025:
1. Emblem: (HIP) Formerly known as GHI (Government Health Ins). They removed ALL group policyholders from their “Prime Network” and forced them into what we call the SKINNY “Select Network” in 2024 where it’s hard to find doctors. Premiums are increasing by 7% in 2025! NO MORE BROKER COMMISSIONS! Good Luck getting service directly from Emblem from mostly non-licensed staff!
2. Oxford: They changed their prescription plan in the “Liberty Network” to Broad RX in 2024, and rates are increasing by roughly 5.3% in 2025! Oxford represents about 70% of the small group (2 or more persons) market.
3. Aetna: Approved NYS 2025 rate increases of 11.3%. Aetna ALSO is discontinuing broker commissions as of 1/1/2025. This leaves the Aetna policyholders exposed with no advocate!
4. Anthem: (Formerly known as Empire Blue Cross) changed their name in NYS after their parent company. Their rates are increasing by 8% in January 2025! Anthem is the most expensive NYS carrier because they pay the doctors top dollar!
The definition of insanity is doing the same thing (such as renewing your same health plan year after year) and expecting a different result!!!

There is a whole other world called “Non-Traditional” insurance which offers access to additional networks through partnerships, associations, and unions such as Cigna PPO, Empire “Blue Card” network, PHCS Multiplan network, and Magnacare on a discounted basis.

It is no secret that the U.S. healthcare system is broken! See below for my top 6 reasons for this:
1. The USA spends over $12,000 per person per year on health-related issues: This is by far the most in the world. Other than Germany at $7,500 per person per year, the rest of the world is under $6,000, meaning we spend twice as much per person as the rest of the world!
2. Obamacare Rules and Regulations: Obamacare is “guaranteed issue health insurance,” meaning all applicants are accepted. Many persons who had no health insurance for years and accumulated health issues were able to secure subsidized plans and “buy a claim!” Buying a claim is when one has no insurance, buys new insurance, and immediately gets that surgery they have needed for years, then cancels the plan!
3. Dependency on Prescription Drugs: Having been in the life, disability, and long-term care insurance business for over 25 years, it is rare to find someone who is NOT taking prescription drugs. Because these drugs are expensive, there is a cost share between the insurance company and the policyholder, further driving up costs.
4. The Juvenile Diabetes and Obesity Epidemic: A recent report from the CDC (Centers for Disease Control) projects a 700% increase in Type 2 diabetes for juveniles under age 20 by 2060!
5. Processed Food Label Rules and Bad Habits: We have a national problem with misleading food labels that must be remedied. There are more than 60 synonyms for sugar, which is found in most baby foods starting the sugar addiction early. In fact, a NEW WARNING is out from the AAP (American Academy of Pediatrics) on ALL products labeled “Toddler Formula,” saying “Products MAY Contain Too Much Sugar and MAY NOT Provide Adequate Nutrition!”
6. No Market for Individuals: In the current state of health insurance, individuals are doomed! If someone doesn’t work for a company that offers group insurance or owns a corporation themselves, they are stuck with “Marketplace” options and a 7% price increase for 2025!
As per the NYS Department of Financial Services website, health insurance rates for individuals in NYS will increase by 12.7% on average next year, while small group rates will rise by about 8.4%.

Because of these 6 reasons, health insurance premiums will continue to outpace inflation!

One potential solution is to look at Non-Traditional insurance offered through groups, associations, unions and partnerships! Some of these plans are medically underwritten, meaning one needs to medically qualify with no pre-existing conditions to get onto the plan. The benefit is having a much healthier pool of policyholders; hence, reducing claims and smaller percentage future premium increases.

To learn more or get quotes, feel free to email me at Rob@InsuranceDoctor.us. Let’s hope you never need to use this insurance!
November 6, 2024
Start with Your Heart
Never has your diet been more important than during what I call the current Covid-19 Era! This is not the time to be going to the hospital or outpatient clinics for heart surgery. One of the most dangerous aspects of Covid-19 is its unpredictability as to which body organs it chooses to attack!

My friend Don recently had a heart attack at age 49 and had stents put in. He had an artery blockage, and the doctor said a better diet could have avoided it. Don’s medical and hospital bills exceeded $160,000 by a large margin. Before his heart attack, he estimates he ate red meat 5-6x/week and had at least 2 alcoholic drinks every day except Sunday’s. He was lucky to survive. He was also fortunate that we implemented a strong group health insurance policy for his 12-employee law firm. Don paid less than $8,000, out of his pocket, 5% of the total claim.

We can all significantly reduce the occurrence of heart disease (regardless of family history) by making modest lifestyle changes. According to the CDC, (Centers for Disease Control and Prevention) more than 800,000 first heart attacks occur annually, with more than half followed by a 2^nd heart attack.

I have always maintained that your diet starts at the supermarket. I understand it can cost significantly more money to eat healthy and organic; however, the cost of not doing so can be much greater!

My top 4 tips to improve your diet (in addition to reducing sugar and alcohol intake) and drastically reducing the odds of heart disease include but are not limited to:
1. Eat a Minimum of 1 or 2 Squares of Dark Chocolate Several Times Weekly: Evidence in the British Medical Journal shows that 1-2 pieces of dark chocolate several times per week may decrease the risk of a heart attack by 37%, compared to those who consume less. Who says prevention must be boring and painful?
2. Include More Fiber in Your Diet: Fiber has what is called a “dose response” to reducing risk. In other words, the more fiber you ingest, the greater your reduction of risk. The average American consumes roughly 15 grams of fiber per day. The American Dietetic Association recommends 25-38 grams of fiber per day. Studies show for every increase of 10 grams of fiber per day, there was a corresponding 14% reduction in the risk of a cardiovascular event and a 27% reduction in the risk of heart disease. Good fiber sources include whole grains, fruits, vegetables, cereals and beans.
3. Consume More Legumes: In a survey by (NHEFS) the National Health and Nutrition Examination Survey conducted using over 9500 men and women, found that those who consumed more than 4 servings of legumes per week (compared to those who ate less than 1 serving per week) reduced the risk of coronary heart disease by 22 percent! Common sources of legumes are beans (great northern, kidney, lima, navy and pinto), peanuts, lentils, green beans, chickpeas, and snow peas in their pods to name many.
4. Eat More Omega 3 Fatty Acids: Eating both plant-based and seafood-based Omega 3’s will reduce your risks and extend your life. Good sources of plant-based Omega 3’s include nuts and ground flaxseed.
The more significant the lifestyle modifications one makes, the closer one will become to potentially preventing this disease from occurring! Even modest changes in your diet will result in significant reductions in risk! The goal should be to become “heart-attack proof,” a term used by Dr. Sanjay Gupta!

In a nutshell, you can pay a little more for food now to prevent paying a lot more later!

Be Positive, Test Negative and Keep the Faith!
April 13, 2021
4 Tips to for a Better Doctor’s Visit

Preparing is key for your aging parents to get the most from their doctor’s visit

If your parents are getting older and have begun to develop medical problems, now may be a good time to accompany them on their doctor’s visits. The following tips can help you make the most out of those visits.

1. Look for signs: If they can’t remember what happened on their last visit or the reason for medications, it’s probably time to get involved. Talk about it first and let them know an extra set of eyes and ears will insure better care.
2. Start a file and get organized: Privacy laws require you will need to receive parental permission from your parents to talk to their doctor so start with getting a HIPPA form signed by them. Copy their insurance cards, keep a list of medications and emergency contact info. Consider getting a power of attorney, living will and health care proxy.
3. Prepare for the Doctors appointment: Develop a list of questions, issues, topics and prioritize. Take notes at the appointment and bring your file.
4. Keep communication open: Let your parents take the lead in the beginning. Use your list of questions and ask for clarification as to why specific medications are prescribed. Ask about side effects and if there’s any food, alcohol and/or over the counter drugs they should avoid. A good website for medication clashes is www.WebMD.com. There are 10,000 people turning 65 every day in the USA. Many Americans are living well past their 70’s. This can be an unsettling role reversal for children as they now need to care for their parents. When you are participating in your parents’ health care you are providing a gift of love that can make a huge difference in their health and well-being.

Contact Rob the Insurance Doctor today for a free no-obligation financial checkup today.

February 5, 2019
5 Tips How to Find a Good Insurance Broker

Insurance brokers and agents are trusted with fitting their clients into suitable life, health, homeowners & business policies to name a few.

There are numerous insurance providers and they are not all the same. It’s important that the broker you choose is well-versed in policy differences from company to company and informed of the latest news, trends, and products. He/she also needs to be concerned with your personal planning needs and capable of explaining your options in a way you can understand.

Follow these tips on what to look for in finding a right insurance broker or agent:

TIP 1: Knowledge and experience: There is no substitute for experience! Look for brokers that have been in their field for a minimum of 5 years. Proficient brokers will usually also have advanced planning designations (insurance degrees) next to their names. Look for at least one of the following 3 designations: CLU (chartered life underwriter) CFP (certified financial planner) or CSA (certified senior advisor).

TIP 2: Independent brokers, not agents: This may be counter-intuitive. In reality, independent brokers are in a better position to help you than “captive agents”. The independent broker represents numerous insurance companies and must be well-versed on all their policies in order to find the best one for you. The captive agent (i.e. Allstate or New York Life) often promote their own company products first in order to qualify for their company-sponsored trips and subsidized health insurance. Make sure your broker places your needs before their own!

TIP 3: Fee structure: Most of the established independent brokers don’t charge a fee for time and/or services. They receive compensation from whichever insurance company you decide to do business with. Beware of agents/planners and advisors that charge steep upfront consultation fees.

TIP 4: Get a second opinion: Most people are already working with an agent/broker. Do yourself a favor and get a second opinion using the tips given in this article. You will be surprised at what you can learn from a free consultation with an independent broker.

TIP 5: Due diligence: Invest the time to call 2 or 3 brokers. Start a small list and ask around. Friends, family or colleagues that are satisfied with their broker are a good place to start. Check for their presence and reviews on the internet and gather as much information as possible.

October 2, 2018
6 Reasons Insurance Companies Know Everything About You
You may want to think twice what you tell your doctor on your next visit. Medical records are now online. When you sign a HIPPA (health ins privacy) form to apply for life, disability and/or a long-term care policy the following information is available with a few mouse clicks:
1. On-line medical records: Insurance companies can and will be able to see what medications you take by doing a pharmacy scan.
2. Driving record: Companies can pull up an MVR (motor vehicle report) which can show drunk driving etc.
3. The MIB: Medical Information Bureau: This isn’t the Men in Black movie, LOL. Companies can see whenever you apply for other insurance policies whether or not you take them.
4. Criminal Record: Databases are linked and they can check on your prior arrest records.
5. Memberships: Companies can see what type of groups, clubs and or organizations you belong to.
6. Social Media: Some companies will look you up on Facebook, LinkedIn, etc to see what type or person you are and your public posts.
December 6, 2017
7 Life Changes to Extend Your Life 10 Years
What if you could make some simple lifestyle changes that could result in major weight loss, lowering cholesterol and/or improving blood pressure readings all without medication or fad diets? Here’s how!
1. Drink Plenty of Water: Generally, adults should be consuming about 2-3 liters/day minimum to stay at peak mental and physical performance. Water keeps you hydrated, curbs your appetite and urges to overload on sugary soft and sports drinks.
2. Eat Nuts: People who eat about two ounces of tree nuts four to five times per week live 2-3 years longer than those that don’t.
3. Move Naturally: One of the harder steps to focus on if you are a 9-5 desk job person. Simple adjustments during the day like taking the stairs instead of an elevator every other trip or taking public transportation instead of driving promotes more walking during your day while saving on gas money and it’s helpful for the environment.
4. Go Green: Fill most of your plates with fruits and vegetables preferably organic. Most Americans consume too much meat which is harder to digest and increases cancer risk.
5. Eat until you are 80% full: If you are starting to feel full, stop eating. Over time your body will adjust to the smaller portions and you will no longer get those hunger feelings and cravings. Another strategy to help the process is to take a 5 minute break when half done eating and you will see that you no longer need to stuff your face until you are about to bust out of your pants!
6. Take part in Happy Hour: Moderate drinkers outlive non-drinkers and of course heavy drinkers. A glass of red wine with friends and/or food can help prolong your life.
7. Find a Healthy Social Circle: Research indicates that happiness and healthiness are contagious. It’s always good to have support from like-minded people. Tell folks about your new lifestyle plans and see what kind of support you get.
These simple lifestyle changes are not easy at first. Don’t think of it as a diet or temporary change. It’s a long-term lifestyle change! Watch the folks around you notice the difference and they will start asking you questions about how you did it.
January 31, 2017
5 Tips for Last Minute Obamacare Shoppers
This Sunday, 1/31/16 is the scheduled deadline for the nationwide enrollment period for individuals and families. If you don’t act soon, you may be stuck with your current plan or uninsured until 2017!

Here are the top 5 tips to consider:
1. Beware of killer out of pocket costs: Affordable premiums are important. But no less important are the out-of-pocket costs (co-pays, deductibles etc.) you face when you get sick. What good is having a plan you can’t afford to use?
2. HSA-eligible health plans can save a bundle: Health savings accounts usually have high deductibles and can save you money. You can also save money on a tax-deductible basis for qualified medical expenses (co-pay deductibles etc.)
3. Subsidies, if eligible can save hundreds per month: If a single earns $47,000 or less ($97,000 for families) they may qualify for subsidy. Don’t leave money on the table!
4. Don’t lie about your income to get subsidy: Any subsidies given by the government will be reconciled on your 2016 income tax return the first quarter of 2017.
Use a broker to help: The premiums are the same whether you use a broker or buy directly through the internet so why not get professional advice for free?!

CALL 917-359-3985
January 29, 2016
4 Important Dates for ACA (ObamaCare) Enrollment
Many of the new rules will go into effect in 2016 and ignorance is starting to get expensive! Some important dates include:

PROBLEM:

Penalties are the greater of 2.5% of household income or $695/person!
1. 11/1/2015: Open enrollment starts through the marketplace exchange for a 1/1/2016 start date.
2. 12/15/2015: Last day to enroll for a 1/1/2016 start date.
3. 1/15/2016: Last day to enroll for a 2/1/2016 start date.
4. 1/31/2016: Last day to enroll for a 3/1/2016 start date and avoid paying a penalty. The last date to enroll for coverage until 2017 unless one qualifies for the SEP (special enrollment period).
The SEP only comes into play if there’s a change in life or a change in status like getting married or losing coverage etc.

SOLUTION: Contact us at 917-359-3985 or on our contact sheet. We can clear up confusion and have access to non-traditional boutique plans that don’t have these deadlines and are priced reasonably.
November 2, 2015
URGENT: Health Republic Ins. of NY Shutting Down
Effective Friday 9/25/15 the NYDFS (NY dept of financial services) has directed Health Republic to cease writing new health insurance policies and to commence an orderly wind-down after existing policies expire. They are only in their 2^nd year of existence and are the first casualty of the new Obama care era. What does this mean for concerned policyholders?
1. For individuals: All policies will run through 12/31/15. That means all individuals will need to initiate changing companies by the middle of December at the latest.
2. For small groups: NYDFS and Health Republic will be releasing guidance shortly concerning small group products.
To read the notice www.dfs.ny.gov/about/press/pr1509251.htm

The Insurance Doctor says: The state claims Health Republic is insolvent and didn’t keep enough in reserves. Health Republic says the Obama care state guidelines are too strict to make money. We feel a combination of both are true and that their rates were too low to earn profits.

Avoid this situation entirely and switch out of Health Republic as soon as possible! Trying to squeeze claim monies from a company going under is a tough task should you be unfortunate to get sick between now and year end.

Feel free to contact us for plan options as we are booking appointments for Health Republic policy owners starting the week of 10/12/15.
October 5, 2015
On NYC Radio

FREE Radio Broadcast Replay!

Click here and listen to Robert Intelisano “The Insurance Doctor”. Listen as Rob shares insights on purchasing health insurance, why bigger is better and much more in his recent interview with KC Armstrong (former producer and cast member of Howard Stern Show) on WRNW1- All Women’s Empowerment Radio AM1100 in New York City.

May 27, 2015