WEBVTT
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00:00:03.037All right, everybody, we're back with Up to Speed. It's Samantha here,
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00:00:06.697and I'm joined with two incredible guests, John and Mary Kananen,
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00:00:12.237who are health care gurus who are going to help us break down the ACA,
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00:00:13.557which is the Affordable Care Act.
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00:00:16.077And specifically, we're going to be chatting a lot about today,
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00:00:18.177Covered California. How are you two doing?
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00:00:22.657Great. How are you? I'm fired up because this is a topic I know very little
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00:00:26.617about, but it's a top of mind of pretty much a lot of Californians out there,
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00:00:30.977not only in the private market buying health insurance, but also agents selling it.
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00:00:33.797So we've got a lot to dive into today.
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00:00:39.297I just want to start and set the table with what exactly is Covered California and who does it serve?
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00:00:51.217Cover California is California's exchange for the ACA where people can go and get APTC,
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00:00:57.757Advanced Premium Tax Credits, or Premium Assistance if eligible, if they're eligible.
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00:01:02.857Anyone can go there, but if you're eligible, that's the only place you can go
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00:01:04.457to receive the assistance.
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00:01:12.657California is a little different also because they still offer the cost-sharing
00:01:12.657 -->
00:01:19.297reductions that help lower the out-of-pocket expenses for individuals below
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00:01:23.597the 250 percent federal poverty level.
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00:01:28.097So things like their deductibles, their co-pays, co-insurance,
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00:01:32.597out-of-pocket taxes are reduced if they are eligible.
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00:01:38.997Okay. So that's a lot to digest. So that just sets our table for the rest of the chat here.
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00:01:42.657So a lot of what we're hearing in the news is a lot of the fights with,
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00:01:46.377you know, why the government's shut down, not working, or, you know,
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00:01:47.637whatever's going on in Washington.
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00:01:50.517A lot of this has to do with health insurance across the board,
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00:01:53.817but, you know, focusing really just on a granular level here in California,
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00:01:58.737you know, what are some of the biggest changes or updates that we know about the 2026 year upcoming?
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00:02:04.517So the addition of the new federal bill has on average increased premiums for
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00:02:09.537individuals utilizing the ACA, especially anyone above the 400 percentile.
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00:02:15.577On top of the annual insurance provider increases of 8 to 10 percent,
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00:02:20.477which makes the changes from 2025 to 2026 look way more drastic.
00:02:21.277 -->
00:02:26.917So pretty much cost sharing reductions are going back to like pre-COVID amounts.
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00:02:32.297Which is interesting because here we are five years later. You know,
00:02:32.417 -->
00:02:35.297a lot of uncertainty is about these federal tax credits.
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00:02:38.277And do you guys have any thoughts and feelings about what that really means
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00:02:41.817to the normal human being who needs that broken down into normal language?
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00:02:45.197So the bill has increased premiums across the board, right?
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00:02:52.337Individuals that are, you know, lower on the federal property level chart are
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00:02:57.637seeing, you know, not that big of increases, whereas the higher income you get,
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00:03:00.837the higher increases you get overall, right?
00:03:02.437 -->
00:03:07.717And a lot of people that were getting assistance at a 400 percentile or higher
00:03:07.717 -->
00:03:10.197are now completely eliminated.
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00:03:15.837So for most of those families, it's like I said, it's a drastic, drastic change.
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00:03:19.577So, yeah, along with everything else that's going up, right? Yep.
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00:03:25.337Talk to us about specifically what California at a state level is doing to offset these premiums.
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00:03:31.857Well, California has set aside $190 million,
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00:03:40.557and they've decided they're either going to use it to reduce the premiums for people below 165%.
00:03:40.557 -->
00:03:47.257So at 138 to 165, below 138%, you go to Medi-Cal.
00:03:47.597 -->
00:03:54.857It's a $0 premium. Once you have 138, you start receiving assistance.
00:03:55.337 -->
00:03:58.157What they're trying to do there is make it so that,
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00:04:05.064from 138 to 165, those people do not see a significant,
00:04:05.404 -->
00:04:11.344they see really no increase in their premium because of the money from Cover
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00:04:15.204California, or from the state of California, sorry.
00:04:15.764 -->
00:04:22.164And it's also, they're talking about using some of it to help.
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00:04:29.072Bring back some of the cost-sharing reductions that have been totally eliminated.
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00:04:33.252So when we're talking about percentages, right, let's break that down to like
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00:04:37.252annual salary, you know, for someone that's making X amount of dollars,
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00:04:41.632you know, what's that dollar amount look like? Who's in that bracket?
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00:04:53.272Well, if you are single, it's from about $21,600 to $23,000.
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00:04:56.472Thousand four hundred dollars or i'm
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00:04:59.752sorry about twenty six thousand
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00:05:02.572dollars twenty three thousand four hundred gets what
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00:05:09.832is called a silver 94 which is an amazing plan some of those people have zero
00:05:09.832 -->
00:05:18.352premiums and they have five dollar co-pays and zero deductible and a fourteen
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00:05:22.272hundred dollar out of pocket max for the year. Wow.
00:05:22.592 -->
00:05:28.132So, and then it goes up to the silver 87, but it's only really reaching about
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00:05:33.512half of those people, which means it would go up to about 26,
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00:05:37.19227,000 a year for a single person.
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00:05:47.812Family of four, we're talking between 44,400 and about 50,000 a year.
00:05:47.812 -->
00:05:50.432And that's for four people in the family.
00:05:51.912 -->
00:05:57.452So when we're talking about ending the end of the enhanced federal subsidies,
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00:06:00.472how does that affect the monthly premiums for people?
00:06:00.632 -->
00:06:04.332I mean, that's that's like how is that affecting the bottom line for the common folk?
00:06:05.152 -->
00:06:09.392So for my clients that are losing all assistance, they are experiencing the
00:06:09.392 -->
00:06:14.392full price rate from the insurance providers, making their premium that possibly
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00:06:18.332was like $1,000 for like, let's say a family of four, right?
00:06:18.612 -->
00:06:25.252Go all the way up to maybe $2,000, $3,000 now because there's no assistance for them anymore.
00:06:25.652 -->
00:06:30.612So this makes it seem unmanageable from a financial standpoint.
00:06:30.612 -->
00:06:36.472Like I have multiple clients that still need to get back to me because it was a shock, right? So.
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00:06:41.652Yeah. I mean, what are people supposed to do? I mean, that's a big, big jump.
00:06:41.952 -->
00:06:45.852You know, what are you advising your clients? And for our agents that are out
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00:06:48.992there dealing with the same parameter, I mean, these conversations and these
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00:06:53.232discussions, I mean, how are you advising them, you know, against their thought
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00:06:56.412of like, hey, I should just let this go or I shouldn't have this health insurance?
00:06:56.412 -->
00:07:01.752So for the most part, we're like exploring different options and plans, right?
00:07:01.972 -->
00:07:07.172Some of these people are on silver plans. There's always bronze plans that are cheaper.
00:07:07.432 -->
00:07:11.592There's also a lot of them are on PPOs and they can move to an HMO,
00:07:11.812 -->
00:07:13.472which are typically cheaper.
00:07:13.872 -->
00:07:16.912And, you know, there's definitely more options out there.
00:07:17.392 -->
00:07:21.632The good thing about some of these people that make more money is that they
00:07:21.632 -->
00:07:26.252have more options available and they might be able to change some of what they
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00:07:28.212had before to something different.
00:07:29.532 -->
00:07:33.872And a lot of this is up top of mind for most people in this space that you guys
00:07:33.872 -->
00:07:37.652are in is because right now we call that open enrollment, if I'm not mistaken.
00:07:38.479 -->
00:07:42.699Yes. And what's that time frame look like? And what does that mean for someone
00:07:42.699 -->
00:07:47.279who's looking to get into the health insurance world as far as a consumer and
00:07:47.279 -->
00:07:49.659also an agent that's getting into selling it?
00:07:49.919 -->
00:07:54.359What's our time frame here and what happens in this period? So open enrollment
00:07:54.359 -->
00:08:02.619for renewals started October 15th and they went till November 1st and then they
00:08:02.619 -->
00:08:04.559implement a passive renewal,
00:08:04.959 -->
00:08:09.979which is pretty much an auto renewal, but you need to still contact your agent.
00:08:09.979 -->
00:08:13.239And then as for everyone else that
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00:08:16.479isn't renewing and they're new to cover california the
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00:08:19.259open enrollment is from november 1st to
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00:08:22.879december 31st if you want a january 1st
00:08:22.879 -->
00:08:28.739start date and then if you want it's still available all the way up till january
00:08:28.739 -->
00:08:35.25931st but your start date will be february 1st so open enrollment goes from november
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00:08:41.2391st to january 31st in total and then what happens What happens if you are outside of that window?
00:08:41.659 -->
00:08:46.219Are you just kind of like, you got to wait? No, there's also special qualifying
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00:08:47.859life events that you can do.
00:08:48.019 -->
00:08:54.259So say you moved from another state or within California, you can get health
00:08:54.259 -->
00:08:57.359insurance or go back and get it through Cover California.
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00:09:02.899Or you lost coverage. Say like, you know, you lost your job and you're not going
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00:09:08.059to go on COBRA or anything like that. You can go to the ACA or Cover California
00:09:08.059 -->
00:09:11.479and still get qualified to get health insurance through there.
00:09:11.939 -->
00:09:16.599So when we're talking to our customers, you know, that are in this enrollment
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00:09:20.559moment, you know, what are some of the things that we can, you know, help them?
00:09:20.719 -->
00:09:25.539I mean, obviously double checking or updating their application to properly, you know,
00:09:26.668 -->
00:09:29.668state their income and the different parameters and the questions.
00:09:29.668 -->
00:09:32.988But what are some of the other things that we can help best prepare our customers?
00:09:33.508 -->
00:09:38.448For the most part, the income is the biggest thing right now,
00:09:38.528 -->
00:09:42.928since that's what's drastically changing a lot of the assistance that people are getting.
00:09:44.148 -->
00:09:49.768But another thing could be, you know, no one wants to hear about this, right?
00:09:49.888 -->
00:09:55.468Because it's hard that people are already getting told that their premiums are going up, right?
00:09:55.888 -->
00:10:01.508But if you don't have your income in there correctly and say comes tax,
00:10:01.668 -->
00:10:06.048you need to do taxes for 2026 and you were getting this amount of assistance,
00:10:06.248 -->
00:10:08.328but they realized you made more than that.
00:10:08.568 -->
00:10:13.328You're going to get hit again because you got too much assistance throughout the whole year.
00:10:13.808 -->
00:10:15.608You don't want to get hit twice.
00:10:16.368 -->
00:10:22.888That's a big nightmare, right? So realistically right now, I'm just trying to
00:10:22.888 -->
00:10:27.368get to all my clients to dial in their income as close as possible, you know?
00:10:28.118 -->
00:10:32.658Across, I mean, other things like address and changes like that obviously needs to be in there.
00:10:33.638 -->
00:10:39.018But that's the biggest tip that I have for agents helping their clients right
00:10:39.018 -->
00:10:40.738now. Yeah. That's going to give them the most.
00:10:41.198 -->
00:10:45.818Lying about your income is not going to be serving you because they're going to find out.
00:10:46.218 -->
00:10:50.938Yes. And once you file your taxes, they're going to see it. Yeah. So. That's a no-no.
00:10:51.298 -->
00:10:54.978You know, are there tools and resources or like different types of calculators
00:10:54.978 -->
00:10:57.218and things that people can kind of go online if they're unsure?
00:10:57.218 -->
00:11:00.258I mean, everybody's kind of, I'm sure, you know, learning about these new numbers.
00:11:00.458 -->
00:11:03.778I mean, is there places that people can go to to get a little bit more information
00:11:03.778 -->
00:11:07.458about, you know, what we're talking about here from a consumer standpoint?
00:11:08.138 -->
00:11:14.038Yes. So for everybody on the Cover California homepage, on the top right hand
00:11:14.038 -->
00:11:16.518corner, there's a link up there that will say shop and compare.
00:11:17.098 -->
00:11:21.378And that's a tool that's a calculator that will ask you for like your zip code,
00:11:21.678 -->
00:11:24.778your ages of your family, how many family members, your income.
00:11:24.778 -->
00:11:31.218And then you can go and see what your possible assistance will be if you get any or you don't. Right.
00:11:31.718 -->
00:11:35.138And that will make it easier for you to have an understanding of what you're
00:11:35.138 -->
00:11:37.118looking at cost wise throughout the year.
00:11:37.298 -->
00:11:43.918But for agents, there is a in their portal on Cover California.
00:11:44.318 -->
00:11:47.038There's agent specific tools. there's a
00:11:47.038 -->
00:11:50.138link on the right hand side of their homepage that will
00:11:50.138 -->
00:11:53.438give them a slew of different tools
00:11:53.438 -->
00:11:56.478to use to help them navigate not only you know
00:11:56.478 -->
00:12:00.138calculators like the shop and compare tool but you
00:12:00.138 -->
00:12:04.118know any type of like question about the user interface for cover california
00:12:04.118 -->
00:12:10.138maybe some of the differences things like that so so for the folks that are
00:12:10.138 -->
00:12:14.358finding that they're you know pricing out of the market for cover california
00:12:14.358 -->
00:12:17.098they got to go into the you know the Shields, the Aetnas,
00:12:17.418 -->
00:12:19.318the health, you know, that type of market.
00:12:19.538 -->
00:12:23.198What are those premiums looking like for folks? Are they, you know,
00:12:23.398 -->
00:12:25.498what's the market like there? Crazy?
00:12:26.633 -->
00:12:29.973Are you talking about the market where it's going direct?
00:12:30.293 -->
00:12:33.793Yeah, like if you can't get into this, you know, if you're not able and eligible
00:12:33.793 -->
00:12:37.393to work in this Covered California world and you want to go to one of these
00:12:37.393 -->
00:12:42.433other markets, like as far as... Well, anybody can go through Covered California.
00:12:42.853 -->
00:12:46.273And I usually suggest if the client is close,
00:12:46.733 -->
00:12:50.073even though they're not getting assistance but they're close,
00:12:50.333 -->
00:12:54.813I put them through Covered California because at the end of the year,
00:12:54.813 -->
00:12:57.773let's say they didn't make as much if they're
00:12:57.773 -->
00:13:01.233entitled to if they were entitled to premium assistance
00:13:01.233 -->
00:13:08.853and didn't get it they will get it in their tax return so that's always but
00:13:08.853 -->
00:13:14.033anybody can go through California cover California well except for Medicare
00:13:14.033 -->
00:13:18.333once you're 65 and older you should really go to Medicare here.
00:13:19.719 -->
00:13:24.399There are instances where they can go through Covered California, but it's very rare.
00:13:27.279 -->
00:13:34.399So basically what happened is with the extension not being renewed,
00:13:34.799 -->
00:13:43.219those people from 400 up who were receiving the premium assistance no longer
00:13:43.219 -->
00:13:47.219are getting it and basically are paying the premium that they would have paid
00:13:47.219 -->
00:13:49.699if they went directly to the insurance company.
00:13:49.719 -->
00:13:54.839So whether you go directly to the insurance company or through Covered California,
00:13:55.279 -->
00:13:57.979your premiums are the same for that policy.
00:13:58.279 -->
00:14:05.639Going to RET gives you a couple more options on policies with different benefits,
00:14:05.639 -->
00:14:08.279so you can play around more on that.
00:14:08.279 -->
00:14:12.619But that's it's
00:14:12.619 -->
00:14:21.159it's the same there's less actually Aetna is not available in most of California
00:14:21.159 -->
00:14:28.679same with United they're available in some areas the main just like Chinese
00:14:28.679 -->
00:14:30.639community is in the Bay Area.
00:14:31.379 -->
00:14:35.919Blue Shield, Kaiser, Health Net, Anthem.
00:14:36.499 -->
00:14:39.659Those are the big providers in most of the areas.
00:14:40.139 -->
00:14:45.299Do you think that most people are going to go into an uninsured status because
00:14:45.299 -->
00:14:48.859they just can't like because they just can't swing it? I mean,
00:14:48.919 -->
00:14:49.899is that where we're going?
00:14:50.319 -->
00:14:53.539I don't think most. There will be some.
00:14:53.919 -->
00:14:56.739I am getting a lot of people saying, how
00:14:56.739 -->
00:15:00.239am I supposed to manage this though so the thought
00:15:00.239 -->
00:15:03.139in their head is probably there but they don't want
00:15:03.139 -->
00:15:06.839to be uninsured right yeah so the
00:15:06.839 -->
00:15:13.419the worst position is the people who need it yeah absolutely need it because
00:15:13.419 -->
00:15:21.019they use it and they're wondering how am i going to pay for this the younger
00:15:21.019 -->
00:15:23.539they are the more likely they are to not.
00:15:24.481 -->
00:15:30.801Take it. But the older they get, the more likely they are to try to figure out how to make it work.
00:15:31.061 -->
00:15:34.341Yeah. I mean, I'm just thinking about somebody that's got a chronic illness
00:15:34.341 -->
00:15:38.721or, you know, has a, you know, cancer diagnosis or diabetes or something,
00:15:38.881 -->
00:15:42.841you know, that's really requires a lot of visits to the doctor.
00:15:43.041 -->
00:15:46.741And I mean, if you're going from a thousand dollars to three thousand dollars
00:15:46.741 -->
00:15:50.921and you're on a fixed income, I mean, come on, like this is not palatable.
00:15:51.881 -->
00:15:56.941And also what they're doing is they're insuring, like a family of four would
00:15:56.941 -->
00:15:59.421insure just the person who needs it. Yeah.
00:15:59.841 -->
00:16:05.561And the others, they're winging it. I mean, I thought property insurance was
00:16:05.561 -->
00:16:09.461a mess, you two. But now we're at a whole other ballpark.
00:16:10.021 -->
00:16:15.281Do you, you know, feel like California, how does California compare to the other states out there?
00:16:15.381 -->
00:16:18.741I mean, that's kind of something that I know very little about.
00:16:18.741 -->
00:16:22.641I mean, are other states having the same situation, or are we just in our own
00:16:22.641 -->
00:16:25.101little bubble over here of crazy?
00:16:25.541 -->
00:16:28.581Other states are in worse situations. Oh.
00:16:29.161 -->
00:16:34.241California is actually very proactive with the ACA.
00:16:34.381 -->
00:16:39.501That's why we put $190 million in this year.
00:16:40.121 -->
00:16:44.381They do more in cost-sharing reductions than most states. Yeah.
00:16:45.196 -->
00:16:51.816Really, for health insurance, it's more expensive than other states because
00:16:51.816 -->
00:16:55.196our cost of living in California is higher.
00:16:55.436 -->
00:16:58.736But if you're going to live in a state for health insurance,
00:16:58.956 -->
00:17:00.636California is a good one to be in.
00:17:01.236 -->
00:17:06.116So here's a question for just your opinion only, but you are kind of like Yoda
00:17:06.116 -->
00:17:07.396when it comes to this mayor.
00:17:07.636 -->
00:17:11.356So, you know, what's your take on the future of the state-based marketplace
00:17:11.356 -->
00:17:13.296like the Covered California?
00:17:13.296 -->
00:17:17.916And, you know, do we feel like we're going to see more local innovation or kind
00:17:17.916 -->
00:17:21.036of move more into this federal dependency, you know, nationwide?
00:17:21.356 -->
00:17:22.856I mean, what do you what's your opinion here?
00:17:23.756 -->
00:17:28.756Nationwide? Well, only 13 states actually have their own exchange.
00:17:29.256 -->
00:17:35.656The rest of the country, the rest of the states depend on the federal exchange.
00:17:36.856 -->
00:17:39.756In California, we have our own exchange. change
00:17:39.756 -->
00:17:43.216California already has been very innovative
00:17:43.216 -->
00:17:46.736I don't think local levels like city
00:17:46.736 -->
00:17:54.816or county are going to do anything but California is already very active in
00:17:54.816 -->
00:18:00.616in the health insurance marketplace so they're going to keep trying to do that
00:18:00.616 -->
00:18:03.436as much as they can I mean,
00:18:03.876 -->
00:18:06.576last year, because of Covered California,
00:18:07.196 -->
00:18:12.896if you went through Covered California for a year insurance and applied for
00:18:12.896 -->
00:18:16.136assistance, even if you didn't get the assistance,
00:18:16.756 -->
00:18:24.616you could get a Silver 73, which gave you a $0 deductible.
00:18:25.643 -->
00:18:31.683Right off the bat. I mean, no other state did that. So it's already pretty active here.
00:18:31.783 -->
00:18:34.963So I would imagine it to be about the same.
00:18:35.243 -->
00:18:39.383Yeah. And I think it's also interesting, too, you know, just kind of looking
00:18:39.383 -->
00:18:44.363at the marketplace where a lot of doctors and a lot of medical professionals
00:18:44.363 -->
00:18:49.143are kind of switching over to more of a concierge-based service because,
00:18:49.543 -->
00:18:53.503you know, that's what people, you know, someone can maybe afford to spend,
00:18:53.703 -->
00:18:57.863you know, $500 to go see a special doctor and nobody has to deal with insurance
00:18:57.863 -->
00:18:59.883companies and they can get what they need.
00:19:00.203 -->
00:19:05.543And I hear a lot about that here in the Bay Area of just people and physicians that I know.
00:19:05.723 -->
00:19:09.503So it's interesting the way the landscape is shifting.
00:19:10.263 -->
00:19:13.003And it's kind of like, I don't know.
00:19:13.103 -->
00:19:16.283I mean, at the end of the day, people need to be taken care of when they're sick. Yes.
00:19:16.383 -->
00:19:19.223Well, concierge doctors are ones who don't
00:19:19.223 -->
00:19:22.763want to deal with insurance companies they they
00:19:22.763 -->
00:19:25.643have the luxury of taking just those
00:19:25.643 -->
00:19:28.663people who can afford it which is not
00:19:28.663 -->
00:19:38.323most of the people it's the more top percenters um but cover california and
00:19:38.323 -->
00:19:45.583actually the whole aca was to make it more affordable for everyone not the people
00:19:45.583 -->
00:19:47.763who already could afford insurance.
00:19:48.143 -->
00:19:53.163Right. And that's unfortunately the people that suffer the most or the people that need this the most.
00:19:53.892 -->
00:19:57.552But sitting in your seat, guys, if there was, you know, one thing that you guys
00:19:57.552 -->
00:20:01.392could change about the current marketplace that you're playing in here,
00:20:01.532 -->
00:20:04.132like what do you think would be better for consumers?
00:20:04.272 -->
00:20:07.692I mean, obviously lower rates, but, you know, what do you think would be some
00:20:07.692 -->
00:20:12.772things that you see that would be helpful if it was implemented?
00:20:13.992 -->
00:20:17.652For me in particular, I think education is huge, right? Right.
00:20:17.992 -->
00:20:22.292So most individuals like I talk to them and they're like, I don't even know
00:20:22.292 -->
00:20:23.832what I'm doing. I don't know what I'm buying.
00:20:24.072 -->
00:20:28.312I don't understand this. And it's like, well, you don't know what you're buying.
00:20:28.552 -->
00:20:32.292Are you buying it? Right. Like you should have some idea.
00:20:32.552 -->
00:20:37.052And they do. Right. They get it. OK, I have insurance to cover me for this. Right.
00:20:37.472 -->
00:20:41.732But that's the basis of their education. But they don't understand like out
00:20:41.732 -->
00:20:45.412of pocket maxes, what their deductible means, like all these different terms
00:20:45.412 -->
00:20:49.152and how to utilize their insurance to the fullest, right?
00:20:49.572 -->
00:20:53.172Because that's what they're paying for every year, right? And some of them are
00:20:53.172 -->
00:20:58.532paying thousands of dollars and they should have possibly been on a lower planet
00:20:58.532 -->
00:21:01.852because they didn't even need to spend the thousands of dollars because they
00:21:01.852 -->
00:21:03.392don't go to the doctor very often, right?
00:21:03.492 -->
00:21:06.852So it's just, for me, I mean, this is a life thing too.
00:21:07.132 -->
00:21:11.212I feel like education is huge for everyone. The more educated you are,
00:21:11.312 -->
00:21:12.972the better decisions we can make, right?
00:21:13.392 -->
00:21:17.792Yeah, I think so. I mean, what are the what's the most common thing that people
00:21:17.792 -->
00:21:21.972don't understand when it comes to dissecting? Is it the deductible?
00:21:22.112 -->
00:21:25.252Is it the out of pocket? Like what what is the those those are the those are
00:21:25.252 -->
00:21:29.792the most of the questions are a lot about like, what does that even mean?
00:21:30.052 -->
00:21:32.992Like, you know, they get like, oh, I go see a doctor. It's this much.
00:21:33.132 -->
00:21:36.152OK, they can they can see and conceptualize that.
00:21:36.272 -->
00:21:40.052But it's like, what what is my insurance actually doing for me?
00:21:40.052 -->
00:21:42.372And when does it like fully kick in?
00:21:42.512 -->
00:21:45.932Like does it fully kick in? They don't know that it fully kicks in once you
00:21:45.932 -->
00:21:47.052hit your out-of-pocket max, right?
00:21:47.172 -->
00:21:52.732Like things like that that could help people realize what they're paying for, right?
00:21:53.559 -->
00:21:57.599Well, and a little bit of this education moment, I think, lies in the hand of
00:21:57.599 -->
00:21:58.999the insurance professionals.
00:21:59.219 -->
00:22:02.119And so I think if you're listening to this and you're like, hey,
00:22:02.199 -->
00:22:05.299I need to know a little bit more about X, Y, or Z, or hey,
00:22:05.759 -->
00:22:09.619you know, I think that it might be useful to my client base if I,
00:22:09.699 -->
00:22:13.939you know, hosted a webinar or something or, you know, a lunch and learn with
00:22:13.939 -->
00:22:16.599my people to help them understand a little bit more.
00:22:16.699 -->
00:22:19.759I mean, going to these places, getting these resources, you know,
00:22:19.859 -->
00:22:22.979talking to people that are the pros that can help, you know,
00:22:23.119 -->
00:22:26.839kind of dissect and navigate, I think is so key because you never stop learning.
00:22:27.039 -->
00:22:30.599I mean, hello, that's what that's what we do here at Lightspeed is we teach
00:22:30.599 -->
00:22:33.759we teach agents how to be better, faster and stronger in their practice.
00:22:33.759 -->
00:22:39.379But, you know, this is something that affects 100 percent of the people out there.
00:22:39.539 -->
00:22:42.879I mean, health insurance is something that, you know, whether you're sick now
00:22:42.879 -->
00:22:45.279or you're sick later, you're going to have to go to the doctor at some point.
00:22:46.639 -->
00:22:49.719And you better you better make sure you've got the proper insurance there
00:22:49.719 -->
00:22:54.459otherwise i mean if you don't have insurance i mean mary like what is a normal
00:22:54.459 -->
00:22:56.879if you got to go to the emergency room and you don't have insurance and say
00:22:56.879 -->
00:22:59.879you break an arm or something i mean what are we talking about it's hundreds
00:22:59.879 -->
00:23:04.919i feel like well if you don't have insurance you're gonna they're gonna ask
00:23:04.919 -->
00:23:08.499you what your income is and put you on medi-cal if they can because then they
00:23:08.499 -->
00:23:09.519know they're getting paid,
00:23:10.637 -->
00:23:16.837They also have what are called cash prices. Still, you're looking at five grand. Yeah. Easy.
00:23:17.697 -->
00:23:24.797You have a baby? Forget about it. Oh, my gosh. Oh, my gosh. You could buy a house.
00:23:25.597 -->
00:23:32.057Yeah? Well, for instance, my husband had a double knee replacement.
00:23:32.497 -->
00:23:38.237The hospital charged $575,000.
00:23:39.077 -->
00:23:44.057Dang. Yeah. That's, I mean, that's, let's say, that's a big number. Yeah.
00:23:44.637 -->
00:23:48.397That's a big number. You know, they ended up not getting close to that.
00:23:48.557 -->
00:23:51.317They got $48,000 from the insurance company.
00:23:51.697 -->
00:23:54.197But what if you don't have insurance?
00:23:55.864 -->
00:23:59.384It's just I wonder this this is just an opinion question again,
00:23:59.584 -->
00:24:03.044too, because a lot of this is these hospitals and these medical providers charging
00:24:03.044 -->
00:24:05.384these ridiculous astronomical prices.
00:24:05.404 -->
00:24:09.304I mean, will there ever be any laws and legislation on, hey,
00:24:09.464 -->
00:24:13.524like, let's let's have a cap on these services, because I really do feel like
00:24:13.524 -->
00:24:16.924it's just kind of a free for like they're going to just throw out whatever number
00:24:16.924 -->
00:24:18.924they can they could possibly get away with.
00:24:18.924 -->
00:24:25.044Well, I have to say the cash price that they have is typically more along the
00:24:25.044 -->
00:24:29.044lines of what the insurance companies pay them.
00:24:29.224 -->
00:24:32.524It might be a little more, but it's along those lines.
00:24:32.724 -->
00:24:36.184So there is that option, the cash option.
00:24:36.704 -->
00:24:45.744But one of the downfalls of the ACA was not putting caps on what doctors could
00:24:45.744 -->
00:24:50.044charge, what hospitals could charge. and what insurance companies could charge.
00:24:50.984 -->
00:24:54.524Yeah. Do you think that everybody can figure that out when they decide to get
00:24:54.524 -->
00:24:57.624back to work there in Washington? Without getting political.
00:24:58.724 -->
00:25:01.964I don't think they're going to work on that part of it at all.
00:25:02.864 -->
00:25:06.184Because at the end of the day, I mean, the people that are profiting are,
00:25:06.184 -->
00:25:10.844you know, these medical providers, in a sense, these hospitals and different things.
00:25:10.964 -->
00:25:14.484And, you know, for the doctors, it's not like they're pocketing the cat.
00:25:14.484 -->
00:25:18.844You know, it's not like they're walking away, you know, a winner here either.
00:25:19.304 -->
00:25:21.464It's mainly hospitals and...
00:25:23.015 -->
00:25:28.415Drug companies. Yeah. Well, that's another episode, guys. And insurance companies.
00:25:29.515 -->
00:25:33.135That's another episode. It's not the agents, I'll tell you that much.
00:25:33.735 -->
00:25:38.315Yeah. And that's another question, too. I know, you know, we've all heard,
00:25:38.495 -->
00:25:41.915you know, the commissions and how they are paying agents now.
00:25:42.035 -->
00:25:46.435I mean, what does that look like right now in the health insurance space,
00:25:46.635 -->
00:25:48.835you know, from an individual standpoint and a group standpoint?
00:25:49.515 -->
00:25:52.755Group is still pretty standard. what
00:25:52.755 -->
00:25:55.775it used to always used to be group is that's why
00:25:55.775 -->
00:25:58.595you will find a lot of agents doing group health
00:25:58.595 -->
00:26:01.715in the individual market it
00:26:01.715 -->
00:26:04.535is well certain companies are pretty
00:26:04.535 -->
00:26:11.055brutal what the agent commission is so if you're going to it's it's more it's
00:26:11.055 -->
00:26:15.595very rewarding because you're helping a lot of people who didn't know what to
00:26:15.595 -->
00:26:23.515do and you know people think we're angels but yeah some of the companies do not.
00:26:23.695 -->
00:26:26.115Some companies are great. They're fine.
00:26:26.575 -->
00:26:33.115But some are not. Yeah. And it's hard to earn a living just doing individual.
00:26:33.115 -->
00:26:38.015You also have to start doing groups to make a living out of it.
00:26:38.215 -->
00:26:41.515Which is tough because, you know, at the end of the day, we're on the front
00:26:41.515 -->
00:26:45.795lines as agents and brokers, you know, obviously educating our clients,
00:26:45.955 -->
00:26:48.095walking them through this journey of mess.
00:26:48.415 -->
00:26:52.255And then, you know, at the end of the day, like, we've got to pay our health
00:26:52.255 -->
00:26:54.315insurance premiums, too. Right.
00:26:56.090 -->
00:26:59.130So that that's a whole other, you know, thing to think about.
00:26:59.310 -->
00:27:03.530So in closing, you know, when you're thinking about like one piece of advice
00:27:03.530 -->
00:27:07.090you could give, you know, someone that's in your seat that's that's battling
00:27:07.090 -->
00:27:09.070this battle right now. I mean, what would you say?
00:27:11.470 -->
00:27:18.150As he takes a deep pause in my seat as as an agent? Yeah. OK.
00:27:19.430 -->
00:27:24.270Just talk to your clients, you know, make sure that they fully understand what
00:27:24.270 -->
00:27:25.830the situation's ahead of them.
00:27:26.090 -->
00:27:30.410So that they can make the best decisions they can make, so that you're serving
00:27:30.410 -->
00:27:32.430your people the best that you can, right?
00:27:33.210 -->
00:27:38.830On my standpoint, though, as, you know, helping myself, it's not really much
00:27:38.830 -->
00:27:42.170I can do better than just trying to be a better person every day, right?
00:27:42.550 -->
00:27:45.750And help people, so. That's the name of the game.
00:27:45.870 -->
00:27:49.870And Mary, you know, what would you give advice to the consumer who's just putting
00:27:49.870 -->
00:27:53.010their head in their hands thinking, you know, how am I going to get through
00:27:53.010 -->
00:27:59.430this? What are some words of wisdom for someone that's been in this business for a very long time?
00:27:59.910 -->
00:28:07.650I sit there and I spend a lot of time explaining their options on going to an HMO,
00:28:08.090 -->
00:28:14.970maybe trying high deductible health plan with an HSA, which is a health savings account.
00:28:16.390 -->
00:28:22.810And coming up with options for what is going on in their life.
00:28:23.270 -->
00:28:31.450And really, the people hit hardest by the non-extension are more middle class.
00:28:31.770 -->
00:28:35.730They're not the poor. It's the middle class.
00:28:36.190 -->
00:28:39.970And, you know, we all have bills and we all have our style of living.
00:28:40.250 -->
00:28:44.910But with middle class, it's like going to be really tough.
00:28:45.110 -->
00:28:49.590But if you can find a solution for less,
00:28:50.716 -->
00:28:56.316that's what you have to do. The other thing I like to do is make sure all of
00:28:56.316 -->
00:29:02.816my clients know that the ACA and Covered California are Obamacare.
00:29:03.156 -->
00:29:08.116Because there's so many people out there that think Obamacare is horrible,
00:29:08.116 -->
00:29:12.376but they love their Covered California ACA plan.
00:29:12.876 -->
00:29:18.696And when I tell them it's the same thing as Obamacare, they go, you're kidding.
00:29:19.276 -->
00:29:23.056Just a different name. It's just a different name. My hat goes off to you both
00:29:23.056 -->
00:29:27.176for, you know, providing just a little bit of insight to all of us and,
00:29:27.236 -->
00:29:31.296you know, myself exclusively because I'm just, you know, it's a world I know nothing about.
00:29:31.396 -->
00:29:34.776And it's a world that I think touches so many people on an individual level
00:29:34.776 -->
00:29:36.276and also on a professional level.
00:29:36.476 -->
00:29:40.616So we hope that everybody gets out there and is kept up to speed.