The Insurance Doctor

Category: healthcare

  • 2025 Health Insurance, State of the Union

    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!

  • Measure Would Cap Insured Out-of-Pocket Cost of Insulin at $35

    Measure Would Cap Insured Out-of-Pocket Cost of Insulin at $35

    The U.S. House of Representatives has passed legislation that would cap the out-of-pocket cost of insulin at $35 a month for people with a group or private health insurance.

    While the measure still must pass a vote in the Senate, it has broad backing after the cost of insulin has skyrocketed in recent years. People who formerly paid less than $100 a month for the vital medication are sometimes paying more than $1,000, depending on their health insurance coverage.

    More than 37 million Americans have diabetes, and this legislation could be a game-changer for the estimated 7 million who must take insulin to control their condition.

    In the past decade, the cost of insulin has tripled in the United States, with average out-of-pocket costs rising to about $666 a month. Some people need specific brands and can pay more than $1,000 a month for their brand.

    For example, David Tridgell, a Minneapolis endocrinologist, wrote an op-ed in the Washington Post citing the costs typical diabetics face:

    • Patients with Type 1 diabetes tend to use two or three vials of insulin per month. At the current cost of one vial of Humalog 50/50, these patients would spend $780 to $1,170 on their insulin every month.
    • Type 2 diabetes patients sometimes need six or more vials a month, which would run up the costs to $2,341 or more every month.

    Because of the soaring costs, many people report reducing dosages or rationing to make their insulin last longer.

                Diabetes can be especially costly for individuals enrolled in high-deductible health plans, in which enrollees must pay the list price for their insulin until their deductible is met. This could mean thousands of dollars out of pocket before the insurer will cover the drug.  Diabetes can lead to other serious health complications, including kidney failure, heart disease, and loss of vision.

    How it would work

    HR 6833 would bar private health insurers, health plans, and self-insured employers from applying a deductible on insulin and require that diabetics pay no more than $35 or the amount equal to 25% of the negotiated price of the selected insulin product, whichever is lower.

    For no more than $35 a month, the Affordable Insulin Now Act would require private group or individual plans to cover both vial and pen dosage forms and any of the following insulin types:

    • Rapid-Acting
    • Short-Acting
    • Intermediate-Acting, and
    • Long-Acting

    Medicare Part D plans, Medicare stand-alone drug plans and Medicare Advantage drug plans would be required to charge no more than $35 for whichever insulin products they cover in 2023 and 2024, and for all insulin products beginning in 2025.

    HR 6833 passed on a vote of 232 to 193, with 12 Republican representatives voting with the Democrats. The measure has been sent to the Senate.  If it passes the Senate and is signed into law, it will take effect in 2023.

    It is critical to take your monthly medications into account when selecting your health insurance.  The “NET Cost” for health insurance is the monthly premium plus your monthly out-of-pocket cost for medications. 

    The fallacy for business owners is that you cannot change your health insurance policy until the end of the year during open enrollment or your plan renewal.  The facts are that you can switch your health insurance plan anytime provided you change insurance carriers!

    If you own a business owner and are unhappy with your health insurance or made a mistake in December, feel free to reach out to us at Rob@InsuranceDoctor.us.

  • Marijuana, the Lesser of Two Evils?

    Marijuana, the Lesser of Two Evils?

    As of the writing of this week’s column, New Jersey Governor Phil Murphy was granted an extension to negotiate with lawmakers on two bills to legalize and decriminalize marijuana in New Jersey.  This is after the measures passed both houses of Legislature on 12/17/2020. 

    “Voters overwhelmingly support the legalization of cannabis and we are taking every step necessary to assure legalization and decriminalization become law,” said Assembly Speaker, Craig Coughlin!

    Looking at this issue financially, it’s a no-brainer.  In 16 states, marijuana is fully legalized for both recreational and medicinal purposes.  13 other states (including New York) have decriminalized and legalized medicinal marijuana use.  There are now only 6 states where marijuana is fully illegal.  Legalizing the drug would be a tax revenue boon for a broke New York State, which Governor Andrew Cuomo has already admitted. 

    I have concerns with this as there will be ripple effects far and wide from legalizing recreational pot in New York State.  Medicinal marijuana has been legal in New York State since 2014.  My first concern is underage children and this easy access to pot potentially getting kids hooked on the drug.  Other issues are regulation, law enforcement and DUI (driving under the influence) of drugs.  People are preoccupied enough on the roads with Covid-19.  It stands to reason if pot is fully legalized then New York State would consider releasing prisoners with non-violent, marijuana possession only records.  New York State spends over $70,000 per year per inmate, the most in the country.

    Conditions we know medicinal marijuana can help:

    1. Chronic Pain:  According to the CDC, (Center for Disease Control) 20.4% of Americans are suffering chronic pain issues.  A developing field in medicine is the application of MM (medical marijuana) to alleviate chronic pain as al alternative to opiates.  This field has gained popularity due to the lack of addictive qualities of MM compared to opiates.
    2. Lack of Appetite: Conditions like cancer can sap a person appetite which is dangerous as the body needs the proper food and nutrients daily.
    3. IBS (Irritable Bowel Syndrome): Medicinal Marijuana eases nausea and pain which makes it a viable option to treat IBS.
    4. Lou Gehrig’s Disease AKA ALS: ALS (Amyotrophic Lateral Sclerosis) is a debilitating neuro degenerative disease that progresses in patients over time.  It affects neuro cells in the brain and spinal cord slowly reducing neuro and motor functions over time.  MM has been proven to slow down the degeneration. 
    5. PTSD AKA (Post Traumatic Stress Syndrome):  PTSD is running rampant in America, especially over the last year during Covid.  Medicinal Marijuana (CBD AKA Cannabidiol) seems to breakdown a chemical in the brain that affects pain, mood, and anxiety.

    There are a variety of conditions or diseases one can be suffering from to obtain a Medicinal Marijuana ID Card which can differ slightly by state.  In general, see symptoms and the process below:

    1. Conditions Most States Include Chronic pain, cancer, HIV/Aids, PTSD, IBS, neuropathy, epilepsy, ALS, spinal cord injury, Parkinson’s, and Hepatitis C to name a few.
    2. Doctor Sign Off Form:  One needs to find a doctor to sign off on the medical marijuana form.  This can be difficult as some doctors are hesitant to prescribe it!  Some reasons are moral, and others are a lack of belief insufficient scientific evidence proving its effectiveness.
    3. Proof of Residence: After proving one is suffering from a condition on their state’s acceptable list by getting a physician sign off, one shows proof of residence like a driver’s license or passport.
    4. Interview with Physician: In areas where MM is legal, patients are approved through a MM recommendation and evaluation conducted by a physician with a medical cannabis license.  Once approved, a patient can legally purchase, possess, and in certain states cultivate their own plants.  For more information go to www.MarijuanaDoctors.com.

    Be Positive, Test Negative and Keep the Faith!!

  • COVID-19: 10 Unexpected Positives

    COVID-19: 10 Unexpected Positives

    I probably watch too much news these days.  It’s not easy to find positive articles.  People often say, “when the dust settles, I’m going to do this or that.” The dust has begun to settle.   What are YOU doing? 

    The other day, I texted one of my Rockaway clients to check-in and see how he and his wife were doing.  My team had been able to save him significant money on his home and auto policy premiums. I was also able to creatively upgrade his health insurance policy, by utilizing a side business he had set up.  He had a major issue with his roof caving in, so I wanted to follow-up on their safety, as well as how the claim was being handled by UPC. They were satisfied with the claim process and said “it was fair.” 

    An avid runner, I asked him what he’s noticed while running since the COVID-19 era began in mid -March.  This turned into an interesting conversation.  We both agreed there is too much negativity going on right now.  We came up with the following list of Covid-19 unforeseen positives:

    1. Simplifies the day: With less activities on the daily schedule, it allows people to be more present and pace themselves.
    2. Getting to know the family better: Families are having more focused and meaningful discussions.  Not always positive, lol.
    3. Less time spent on events: He prefers the drive-by celebrations showing respect, without taking up a large portion of the day.  It removes the uncertainty of deciding how long to stay at an event, without offending people by leaving early.
    4. Much less junk mail:  Have you noticed how little junk email and regular junk mail you are now receiving?  On one occasion last year I received  over 50 emails overnight.  Now I’m averaging less than 10, saving time.
    5. Saving money by eating home: Personally, I’m a foodie and really miss dine-in restaurants.  That being said, money has been saved.  Credit card bills going down. 
    6. Helps focus on a better diet: This is an opportunity to cook more healthy food at home, and to avoid fried food.
    7. Increases gratitude: These are introspective times when we realize that sometimes we take things for granted.
    8. Time for hobbies and self-improvement:  Whether it’s reading books, learning a language or trying something new, these are good times to explore your interests.
    9. Improves the environment: With less automobile traffic, he’s noticed cleaner air and in Riis Park more wildlife.  For the first time he’s seen snakes (non-poisonous) and rabbits on his running trail.
    10. Amplifies your passions: These are times that you miss things you Love.  For me it’s travel, writing, sports and my quest for the best pizza!

    What are YOUR passions? To continue these discussions, feel free to reach out to me at Rob@InsuranceDoctor.us

    Stay Safe and remember to wear your mask! 

  • 7 Tips to Successfully Work Remotely

    7 Tips to Successfully Work Remotely

    Due to Covid-19, millions of Americans are or will be working from home starting this week.  Follow these Lucky 7 tips in order to have a successful work from the home transition:

    1. Bring the office home: Make sure you have specific office supplies on stock at home in addition to more food.
    2. Designate a desk: A fixed workstation is an essential part of any good remote workplace.
    3. Consider setting up 2 screens: Studies show working with two screens increases productivity by 42%.
    4. Comfortable office chair: Consider an ergonomic office chair to help you focus on work.
    5. Office room location: If you are new to a home office, consider a room far from the kitchen and household foot traffic.
    6. Noise-canceling headset: Noise-canceling headsets help one focus by blocking outside distractions.
    7. Set up home mailing process: Consider setting up a Fed-ex and/or UPS account or get more stamps as you will use the U.S. mail more often when working remotely from home

  • 7 Coronavirus Myths debunked

    The Coronavirus is here in the USA and has already proven deadly in Washington state!  Do you think you know all about it?  Read these 7 debunked myths and find out for yourself.

    1. Surgical masks will protect me from the virus: Surgical face masks are not designed to block out virus particles nor do they lay flat on the face.  They can prevent or decrease the chances of spreading the virus if you already have it because Corona spreads from “respiratory droplets”. It happened to a cabbie in Thailand who contracted it from a passengers’ sneeze on his face and neck.
    2. Coronavirus is less likely to get than The Flu: Not necessarily.  To see how much a disease will spread scientists use a formula called Ro (R-naught).  The Ro for the flu is 1.3 meaning the average person will infect 1.3 people and the Ro for the Coronavirus is 2.2 plus there’s no vaccine yet. 
    3. Getting the CoronaVirus aka Covid-19 is a death sentence: Not true, as 81% of reported cases are mild, 13.8% report severe cases, 4.7% are critical (meaning multi-organ failure) and thus far about 2.3% have resulted in death.
    4. Pets can spread this new virus: Not necessarily as scientists reported one dog in Hong Kong tested “weak positive”, meaning it could have either contracted the disease or picked it up from a contaminated surface with its face or nose.  Thus far there are no known animal cases (cats or dogs) to date although it’s possible that bats were first infected then passed it to humans like SARS-CoV-2.
    5. If I have the CV I will know it: No, you won’t!  CoVid-19 has a variety of symptoms like a fever, cough and runny nose that can feel just like a cold.  Early on, infected people may show no symptoms at all. 
    6. It’s unsafe to receive a package from China: It’s safe to receive letters or packages from China.  For the virus to survive there needs to be a combination of certain conditions like temperature, lack of UV exposure and humidity.  According to the CDC “there’s likely a low risk of spread from products or packaging that are shipped for a period of days or weeks at ambient temperatures”.  A past study said it could survive on surfaces like metal, plastic or glass for 9 days but the surfaces on the packaging are not ideal for the virus to survive.  (Source is the Feb. 6th Journal of Hospital infection report).
    7. The vaccine is coming soon in 2020:  Not in this country folks.  If the vaccine were ready today, we would be lucky if it came out this year.   There are numerous regulations, testing and hoops to go through before a new vaccine could be approved nationwide by the FDA.
  • 10 Tips to avoid gaining weight this winter

    10 Tips to avoid gaining weight this winter

    The winter is a time when many folks (especially in cold weather states) hibernate and gain weight.  Diet fads and quick weight loss schemes rarely work.  Changing habits and lifestyle choices are a better way to approach the issue.

    1. Be realistic: Setting unrealistic goals that won’t be achieved is a good way to get depressed and gain weight. Set modest short-term goals to lose weight safely.
    2. Don’t skip meals: Skipping meals will cause your blood sugar to drop, often causing irritability and less efficient burning of calories.
    3. Eat light snacks before going out: Having a small piece of fruit, yogurt, cheese or almond butter on an apple or banana will make you less likely to binge on fatty food late night.
    4. Eat slowly: Chew your food slowly and thoroughly so you can taste and enjoy it. Chewing aids the digestion process.
    5. Be selective: Eat small portions of your favorite foods including protein, high-fiber options and veggies. Try to avoid eating sweets or carbs without proteins.
    6. Take a 5 minute time out mid-meal: Taking a time out starts digestion and can curb your appetite for seconds.
    7. Choose beverages wisely: Try to avoid sugary drinks. Alcohol is also high in calories, about 7 per gram. Liquors, sweet wine and sweet mixed drinks contain between 150-450 calories per glass.
    8. Exercise: Classes and group activities can work and folks can be supportive.  Other options are stationery bikes or just get the dog out for a long walk and/or jog.
    9. Eat omega 3 fats: Fish oil is important year-round for it’s proven ability to reduce heart disease, decrease pain while supporting blood sugar balance.
    10. Celebrate life!: Make a list of everything that makes you happy and try and do one of those things every day.To trim the ‘fat’ from your finances contact the Robert here. 
  • 5 Hands-Only CPR Steps to Save a Life

    5 Hands-Only CPR Steps to Save a Life

    Crazy things can happen in split seconds especially with kids back in school.  Follow these Hands-Only CPR steps to save a life.  It might be yours one day!

    1. Take charge & delegate: Have one person call 911 on speakerphone, one wait for the ambulance and one get the AED (external defibrillator).
    2. Check their breathing: You want to check their breathing every 5 seconds to prevent overly compressing the chest.
    3. Use the heel of your hand: Using the heel of 1 hand with the other hand behind it compress the chest about 2.5 inches deep.  Pump in the middle of the chest by the nipple line.  Pump at the same pace as the “Bee Gees” Stayin Alive song.
    4. For small kids and infants too: For small children use only the heel of one hand and use 2 fingers for infants.
    5. Use only a hard surface: Lie down the distressed person on the ground or a hard surface.  DO NOT use a bed!  Hopefully, you will never need to use this.  We were told it’s going to be a mandatory part of high school curriculum’s across the country however adults need this knowledge too!

  • 4 Tips to for a Better Doctor’s Visit

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    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.

  • 7 Life Changes to Extend Your Life 10 Years

    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.long-life-sign
    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.