The New Open Enrollment Period for Health Insurance

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Christopher DeBari:

This evening we are honored to have with us a very good friend of mine, Denny Eister. Denny is an independent insurance agent who specializes in healthcare and in Medicare and he has agreed to come on tonight and discuss with us certain aspects of healthcare with particular regard to the new open enrollment that has been put in place by the new administration. Denny, it’s a pleasure having you with us tonight. Tell us a bit about yourself.

Denny Eister:

Thank you. Happy to be here. Happy to be able to educate some of the people on really what’s going on.

Christopher DeBari:

Absolutely.

Denny Eister:

Born in Monterey, California. Grew up in Flint, Michigan. The town that had all the water problems. Fortunately I left before they had the water problems, so it didn’t impact me in any way. I’ve moved around the country a little bit as I have a wife that’s in the hotel management business and they have hotels all over the country. Chris and I are together in a business networking chapter and that’s where we kind of built our friendship and our acquaintance. And I’m licensed in five different states. I practice on the Federal exchange. I’m licensed on the Washington State exchange. I’m registered with many, many insurance companies so I don’t just represent one company. I’m able to find the best insurer out there, with the insurance product that’s going to fit your need. So I’m just happy to be here, and any questions or issues that you have, please let us know.

Christopher DeBari:

Absolutely. We have Terry [Dunnick 00:02:09] checking in with us this evening. Good evening, Terry. Thank you for watching. She lives in Monterey, California.

Denny Eister:

Small world.

Christopher DeBari:

Small world, absolutely. Now you said that you work with multiple companies. Why is it better to go with somebody that has that ability?

Denny Eister:

Well, early on in my insurance career, I kind of got locked into one company, and I won’t say any names, and their philosophy was, “Lock these agents in.” That’s the only product that they can offer. So early on I learned that, “Hey. There’s a whole lot of different products out there that fit people’s needs, and one product is not the solution for everybody’s needs.” So it just made sense to me to hook up with a lot of these other insurers, the big name insurers, because of all the different product offerings that they have.

Christopher DeBari:

Very good. And one of the things that I wanted to hit on with you this evening, and it’s obviously a very, very important program, is the Affordable Care Act. Can you please explain to us what the Affordable Care Act is?

Denny Eister:

Well I think it’s known by other names, such as Obamacare, and I think the current administration is doing a smart thing because of all the disruptions that are taking place with the current pandemic. I think by opening up an open enrollment period from February 15th through May 15th, I think it’s going to give it a lot of people the opportunity to, if they’ve lost their insurance or if their income has drastically dropped, to get in, make the necessary changes they need to make, to really protect their family.

Christopher DeBari:

Now a lot of people hear Affordable Care Act, or they hear Obamacare, and they just hear the idea that the government is going to be insuring you, but that isn’t really the case, is it?

Denny Eister:

No. It’s really not. And I don’t want to get super complex here, but it’s driven by the federal poverty level to determine how much of a subsidy you can get. The income ranges go anywhere from, I mean, for a single person, 400% of their income. If the federal poverty level is, for a single person $12,760, suddenly a single person earning up to $51,040 is still eligible for a subsidy.

Christopher DeBari:

And how does that work?

Denny Eister:

And another example, a family, let’s say a family of eight, which is kind of extreme, but just to make my point, 400% of that, they could earn $176,000 and still be eligible for a subsidy. And all they’re doing is they’re paying part of your insurance premium. So it’s geared towards assisting people, but they need really need to learn the process and understand what’s going on to follow this process through and to get the kind of coverage that they really need for their families.

Christopher DeBari:

And there seem to be so many things that people hear, but yet people are yet so uninformed about the finer points of this program. So this obviously is something that’s in place for people who qualify for a lower income type of assistance, but who provides the subsidy? Is this something that’s provided by the Federal Government or the state?

Denny Eister:

Yeah, the government provides the subsidy. I mean, that’s the way it was structured from the get-go, that as long as a few things were included in Obamacare, pre-existing conditions don’t come into play. You can’t-

Christopher DeBari:

Now-

Denny Eister:

Go ahead.

Christopher DeBari:

Let’s not take for granted that everyone knows what that means.

Denny Eister:

Okay.

Christopher DeBari:

What is a pre-existing condition, and how does that come into play?

Denny Eister:

If you have a heart condition, if you have COPD, if you have kidney issues, anything like that, you can’t be turned down because of pre-existing conditions. And that was one of the key things when they passed this particular program, was to make sure that those people had access to coverage. Because in the past they didn’t, they were highly rated by the insurance companies, they just couldn’t afford the coverage.

Christopher DeBari:

So they can’t be denied coverage under this program based upon having a pre-existing condition of any kind.

Denny Eister:

Correct.

Christopher DeBari:

That’s very, very good. So if a person does have a pre-existing condition and they apply, will they be getting insurance through an individual company, or something different?

Denny Eister:

Yeah. If you’re going to participate in the federal exchange, as it’s called, or the marketplace, you have to abide by the rules. And the rules are, you can’t eliminate people because of pre-existing conditions. So in other words, everybody buying insurance is subsidizing those people through their premiums.

Christopher DeBari:

Hmm. And what are the types of people that you… Who are the types of people that you insure?

Denny Eister:

Just about everybody. I mean, anybody that does not have company insurance, individuals, families, a lot of 10-99 employees out there that aren’t W-2, self-employed people. There’s a awful lot of people out there that are eligible for this kind of coverage.

Christopher DeBari:

Now you’ve done some fantastic work with my clients in the past, and we certainly appreciate that. And you’ve really gone the extra mile and gotten them good coverage. And quite frankly, many of them didn’t realize how affordable decent coverage can be.

Denny Eister:

Well, that’s probably the fault of the industry for not really educating the consumer to the extent they need to be educated. I mean, you really need to know about this, or at least have access to somebody that could explain it to you. Just sit down, talk with them, get your questions answered and develop a comfort level with somebody, and once you’ve done that, it makes the whole process so much easier.

Christopher DeBari:

So there’s no harm, there’s no obligation in just asking the questions, right?

Denny Eister:

Yeah. It’s like your industry. I mean, you’ve got all this knowledge on tap. Somebody just has to sit down with you and ask, “Hey, can you help me out here?” And you’re happy to do it.

Christopher DeBari:

Sure. And like me, you go the extra mile for the clients and they certainly appreciate that.

Denny Eister:

Sure. And the beauty of-

Christopher DeBari:

I’m sorry.

Denny Eister:

The beauty of my business is they don’t pay me anything. The insurance company pays me, so I don’t cost them anything I’m free.

Christopher DeBari:

Oh. So, yeah, so there’s no benefit to you other than what you’re able to provide for people.

Denny Eister:

Absolutely correct.

Christopher DeBari:

That’s fantastic. And which companies are in the state of Florida that people could potentially obtain coverage with, that you do business with?

Denny Eister:

If I went through the marketplace?

Christopher DeBari:

Yes.

Denny Eister:

Ambetter is a new one, which is owned by Centene Corporation, which is buying up a few companies in the area. They’re probably the number one ACA insurer in the country, and just growing bigger and bigger. Oscar healthcare is a Google backed finance healthcare company that’s growing by leaps and bounds. Good solid companies. Florida Blue I don’t do, they’re in the marketplace. And there’s a lot of smaller companies, but I kind of limit myself to the ones that I think provide the best products for the consumers.

Christopher DeBari:

IS UnitedHealthcare getting back in the game in Florida? I thought I heard that.

Denny Eister:

They’ve talked about it. I haven’t seen anything yet. I wouldn’t be surprised that they will, because for a while there the government had a reimbursement program and they just left some companies without the reimbursement that they were supposed to get, and a few companies had to go bankrupt. So, I think they cautiously are watching to see what’s going on. But I think UnitedHealthcare, and I think Cigna, and some of the bigger companies, are getting back in the marketplace, which will give the consumer more options.

Christopher DeBari:

Now, if I’m a person that were looking to purchase insurance, now, you said you can go through the exchange. Is there another option?

Denny Eister:

Well, I think what you want to do is you want to connect with an agent who can guide them through that process because it’s not as user-friendly as it’s portrayed to be in the media. I mean, there’s a process you’d have to follow, and there are some people that can get through it, but it’s a lot more aggravation than dealing with somebody that really knows the process.

Christopher DeBari:

Now I understand in recent years that the requirement of, or I should say the penalty for not having insurance is no longer in place. Denny Eister:

Correct. Yeah, they eliminated that. I think that was probably done during Trump’s administration.

Christopher DeBari:

Now, does the fact that people no longer have that obligation, does that affect you in any way? In how you deal with the public?

Denny Eister:

Well, it doesn’t hurt me as much as it hurts the people that are going without insurance. I mean, along with no insurance, they were getting huge fines and that was just kind of a double loser.

Christopher DeBari:

Yeah. So which… Hey, Kylie is here to see us tonight, Kylie [Lemars 00:11:13] online. Hey, Kylie.

Denny Eister:

Hey, Kylie, how you doing?

Christopher DeBari:

Thanks for popping in today. Appreciate you doing that. Now, Denny, if I were somebody that wanted to price policies and so forth, what types of options exists? I mean, do I have to have a full-blown policy? Are there temporary policies? How does that work?

Denny Eister:

Well, I mean, you’re talking two different realms. There are temporary policies, sometimes called bridge policies, to get you from one point in time to another point in time. Like if you’re between jobs, or you got laid off for a while, you can buy a temporary policy at a reduced cost, typically higher deductibles, low premiums, and they’re pretty much catastrophic coverage. You can go to healthcare.gov and plug in your zip code and other information, and just look at what’s available in your area. And then you can make a decision because, I mean, we can get into… There are bronze plans, there are silver plans, or gold plans, or platinum plans, all different coverages by the insurer, and you have a portion of that as your deductible. So there’s a lot of different things involved here, and I guess I’m over-simplifying it, but you can go to healthcare.gov, plug in your zip code, and it should give you a variety of plans that are available in your area.

Christopher DeBari:

And what should people be looking for? Are they looking… Do they want a higher deductible? Do they want a lower, I mean, what is the thing to look for?

Denny Eister:

I think it really depends on their comfort range, and their income, their reserves that they have in case they had a medical emergency. If they don’t have a lot of reserves, obviously you don’t want that deductible too high, because then you’re just facing disaster should you have some sort of issue like that.

Christopher DeBari:

And, if you could, explain to us what a deductible is, and how it operates with regard to an individual and as to a family.

Denny Eister:

Excuse me.

Christopher DeBari:

No worries.

Denny Eister:

A deductible is typically, the insurer will cover, for example, if you’ve got, let’s say a silver policy, which means the company’s going to pay 70%, you’re going to pay 30%. All right, a portion of that 30% you’re going to pay is probably deductible. There may be a copay, for example, you go see your primary care physician and he charges you, let’s say a hundred dollars. Okay, your deductible could be 30% of that, which would be you pay $30, and if there’s any copays, a portion of that would kick in too. So let’s say your doctor charged you a hundred, you had to pay 30, you had a copay of $5. So you’re going to end up paying $35, and the insurance company would pay 65.

Christopher DeBari:

Okay. So basically the dynamic of that is do you want the higher copay or do you want the higher premium?

Denny Eister:

Absolutely correct.

Christopher DeBari:

Okay. Okay.

Denny Eister:

And that’s how they work. I mean, the higher the deductible, $10,000 deductible, you’re going to have a fairly low premium. And the higher it gets, the lower your premium.

Christopher DeBari:

Yeah. What’s the dynamic of how the premium works for an individual and as a family unit?

Denny Eister:

I’m sorry?

Christopher DeBari:

The deductible, as it applies to an individual in a family, and the family as a whole.

Denny Eister: There is, in a family policy, there’s an individual deductible. So if each person went to the doctor, they’re going to pay the example we just talked about, but it’s capped at a certain amount. Each policy is

different. So for example, if they went to the doctor four or five times a year, and they ran up to like, let’s say $500, all right? Once they hit that $500 figure, after that, then it’s fully paid.

Christopher DeBari:

Okay. And that’s for the individual, but what about the family as a whole, is there a [crosstalk 00:15:06]?

Denny Eister:

All right, let’s say the family total is a thousand dollars. Once they hit that thousand dollars, then it’s fully paid.

Christopher DeBari:

Now, how does that differ in a Medicare policy?

Denny Eister:

Medicare is obviously for a little lower income people, so typically they subsidize that a lot more than they do the normal Affordable Care Act policies.

Christopher DeBari:

Are there any limitations on who can apply for Medicare?

Denny Eister:

Yes. They have to be below the federal poverty level.

Christopher DeBari:

But that’s not an age based thing, it’s actually a need based.

Denny Eister:

Yeah. It’s actually income driven.

Christopher DeBari:

And what is the difference between Medicare and Medicaid?

Denny Eister:

Medicaid is obviously government funded, it’s hard to give you just a solid example, because different states have different Medicaid programs that cover different amounts. But typically it pays, I mean, they have a select group of physicians and hospitals they work with, and they pay at a much higher rate than the Affordable Care Act people, but the people that have the money to afford a little bit more.

Christopher DeBari:

Now, under the Affordable Care Act, policies that are issued under the Affordable Care Act, are those HMO policies, are they PPO policies?

Denny Eister:

They’re a combination. I mean, obviously you have choices to make once you look at your options.

Christopher DeBari:

I know that a little while back President Obama had said that you will not have to sacrifice your doctor, you get to keep your doctor. And I know that some people were a little disappointed, because that wasn’t necessarily true. But how much flexibility do people have within those plans to treat with whom they want to?

Denny Eister:

I think Saturday Night Live had a lot of fun with that. On an HMO you’re restricted to your Primary Care Provider. He is the quarterback. He is the one that calls the plays, tells you where to go, who to see, whether he authorizes it or not. Whether it’s medically necessary. PPO, Preferred Provider Organization, means you can go to whoever you want to, as long as they’ll provide care and accept the terms of payment that your insurance company issues.

Christopher DeBari:

Then you don’t need that primary care referral in that situation.

Denny Eister:

Correct. That’s the advantage of the PPO.

Christopher DeBari:

PPO. Okay. And if you can just give us an idea of just a garden variety PPO type of policy that you may write for somebody that’s looking to for coverage under the Affordable Care Act.

Denny Eister:

I think probably the average, I mean, I can think of a couple people, single massage therapist, that’s one of my clients, probably makes about 30-35,000 a year. Her premiums run probably in the mid twos, for a pretty decent policy.

Christopher DeBari:

That’s just a monthly payment.

Denny Eister:

Yeah, and she has a small subsidy to go along with that. So it’s probably, the policy might be worth close to $400, and she’s paying around 250 for it.

Christopher DeBari:

That’s not bad.

Denny Eister:

So yeah, I mean, you need to find somebody that can guide you through the process, that can do some research for you, plug the right things into your head that you should be thinking about, because a lot of people just don’t care.

Christopher DeBari:

Well, you and I have that in common. We both have the kind of job that people don’t like to think about existing in the world until they need it.

Denny Eister:

Right. Absolutely correct.

Christopher DeBari:

However, in your particular case, they really need to think about it long before they need it, don’t they?

Denny Eister:

Absolutely. Yeah, because there’s nothing worse than having something, and I hate to go to this, but something bad happen and not have the coverage for it. Eliminate your life savings, and medical bankruptcy, it’s kind of an ugly thing. And medical bankruptcy, 60% of the people that do that have had insurance, they just didn’t have the right kind of insurance or enough insurance.

Christopher DeBari:

Right, and you’ve heard me lament that during our business networking meetings, and so forth. All about how people aren’t carrying the type of insurance they need to protect others, or themselves, properly. [crosstalk 00:19:31]

Denny Eister:

Absolutely.

Christopher DeBari:

I guess it’s no different with health insurance. As we get older, the chances of things going wrong just naturally increase.

Denny Eister:

Yeah. I mean, you could equate it to an old car. It was great when it was new, and everything was perfect, and all that, but as it ages, you got to replace the tires, you got to… [crosstalk 00:19:55] There’s a lot you need to do.

Christopher DeBari:

Well, that’s great information, Denny. So how can people get ahold of you? How best for them to get ahold of you so they can consult with you about the type of insurance that is available and what they may need?

Denny Eister:

Well, I mean, they can email. I have a very easy email addresses. It’s denny@dennyeister.com. Just email, or I’m happy to leave a phone number, if you suggest that.

Christopher DeBari:

Yeah, leave a phone number, please.

Denny Eister:

407-716-4789.

Christopher DeBari:

Is there anything you think we left out this evening that you wanted to mention?

Denny Eister:

If we’ve had any questions, were there any questions?

Christopher DeBari:

None from the gallery right now.

Denny Eister:

Okay, all right.

Christopher DeBari:

A lot of people are actually going to be seeing this after it airs live.

Denny Eister:

Okay.

Christopher DeBari:

They’re still going to have that information.

Denny Eister:

They can email me, email is probably the preferred way. Because the phone system anymore, you get so many robocalls and things, it’s not effective, you know?

Christopher DeBari:

So that was Denny-

Denny Eister:

denny@dennyeister.com.

Christopher DeBari:

Okay. And as far as the open enrollment period is concerned, how long is that going to last for?

Denny Eister:

Well, it starts February 15th and it runs through May 15th. So you got a 90 day period to really take advantage of the opportunities that you didn’t during the last open enrollment. So this is really a great thing for the consumer. And even if your income dropped, you can go back in on your existing policy, put the changed income in, and it’ll drop your payment.

Christopher DeBari:

That’s fantastic.

Denny Eister:

Yeah. That’s just a lot of things to think about, and talking to somebody is the first step. Talking to somebody that, a professional like yourself, or I consider myself a professional too, in what I do.

Christopher DeBari:

Absolutely. Well, Denny, thank you very much. I mean, this is great information, very necessary information. And the reason I do this weekly program is I want people to be informed. So thank you for coming on board. And I would urge anybody in the listening audience to contact Denny, even just to discuss your coverage, because he may be able to do better for you. He may be able to inform you of things that you don’t know, that you need to know. Now you have open enrollment opportunities for people that need coverage, or need to maybe take a look at what their coverage options are. And so that extra 90 days that the government’s affording, I think that’s all good. But Denny, thank you very much.

Denny Eister:

My pleasure, thanks for having me.

Christopher DeBari:

It’s been my pleasure. Thank you. Folks, thank you for tuning in this evening, and as I indicated earlier, you can, don’t smash the like button, that’s a little too hard. Assertively push the like button. I’m not into smashing like buttons. Comment or share below, and like I said, I appreciate your comments, and your criticisms, and your questions. And folks, thank you very much. And we will see you next week where we’ll be discussing arbitration. Exciting. We’ll see you then. Thank you. Thank you, Denny.

Denny Eister:

Thanks Chris.

For more information please call

Chris DeBari

727-656-7852

or email

Chris@cdbinjurylaw.com

Chris Debari

Chris Debari

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