Ten Essential Questions to Ask Your Health Insurance Broker


Selecting the right health insurance plan for your company is a critical decision that can significantly impact the well-being of your employees and the financial health of your organization. To make an informed choice, it’s crucial to engage with a knowledgeable health insurance broker who can guide you through the complex world of healthcare coverage. Asking the right questions will help you understand the options available, assess their suitability for your company, and ensure you make the best decision possible. In this blog post, we’ll discuss the top ten questions you should ask your health insurance broker to make an informed choice for your company’s healthcare needs.

  1. What are the available plan options? Begin by understanding the different types of health insurance plans available, such as HMOs, PPOs, and high-deductible plans. Ask your broker to explain the pros and cons of each option and help you assess which one aligns with your company’s budget, employee needs, and network preferences.
  2. How does the enrollment process work? Ensure you understand the enrollment process, including deadlines, required paperwork, and any other necessary steps. A competent broker should be able to guide you through the process and help streamline it for your employees.
  3. What is the cost structure of the plan? Understand the cost breakdown of the plan, including premiums, deductibles, co-pays, and out-of-pocket limits. Ask your broker to provide specific details about employee and employer contributions, ensuring transparency and clarity.
  4. Are there any wellness programs or additional benefits? Inquire about wellness programs or additional benefits that may be offered alongside the insurance plan. These can include services like preventative care, telemedicine, employee assistance programs, and access to health and wellness resources.
  5. How does the network of healthcare providers work? Discuss the network of healthcare providers associated with the insurance plan. Ensure that the network includes preferred providers in your area and inquire about the process for seeking out-of-network care if needed.
  6. Do you have any strategic partnerships that enhance your services? Many health insurance agencies often collaborate with HR tech companies, compliance firms, payroll service providers, and other related entities to offer comprehensive solutions to their clients. These strategic partnerships can enhance the overall employee benefits experience by integrating health insurance services with other HR and administrative functions.
  7. How are prescription drugs covered? Prescription drug coverage is a crucial aspect of any health insurance plan. Ask your broker to provide details on formularies, co-pays, mail-order options, and any restrictions or limitations regarding specific medications.
  8. What customer support is available? Inquire about the customer support provided by the insurance carrier and broker. Understand how your employees can access assistance for benefit inquiries, and general questions related to their coverage.
  9. What tools or resources are available for employee education? A well-informed workforce is better equipped to make the most of their health insurance benefits. Ask your broker about the availability of educational resources, online tools, or mobile applications that can help employees understand and manage their coverage effectively.
  10. How will the plan be evaluated and adjusted over time? Health insurance needs can change over time, and it’s essential to have a plan that can adapt accordingly. Discuss with your broker how the plan will be reviewed, evaluated, and adjusted as needed to accommodate your company’s evolving healthcare requirements.


Selecting the right health insurance plan for your company requires careful consideration and the guidance of a knowledgeable health insurance broker. By asking the ten questions outlined above, you can ensure that you are making an informed decision that aligns with your company’s budget, employee needs, and long-term healthcare goals. Remember, a trusted broker will provide valuable insights and help you navigate the complexities of the healthcare system, ultimately ensuring the well-being of your employees and the success of your organization, while creating competitive advantage.

Revolutionizing Healthcare: The Synergy of IoT and AI in Kissick’s Iron Triangle


In the realm of healthcare, the quest for improved cost, quality, and access has been a long-standing challenge. However, with the advent of the Internet of Things (IoT) and Artificial Intelligence (AI), a new era of transformation has emerged, presenting unprecedented opportunities for addressing the intricate dynamics within Kissick’s Iron Triangle. By harnessing the power of IoT and AI, healthcare systems are making remarkable strides in enhancing cost efficiency, elevating quality standards, and expanding access to care. In this blog post, we will explore the impact of IoT and AI in revolutionizing healthcare within the context of Kissick’s Iron Triangle.

Kissick’s Iron Triangle:

Kissick’s Iron Triangle (Kissick, 1994), also known as the healthcare delivery triangle, is a conceptual framework that represents the interdependent relationship between three fundamental dimensions of healthcare: cost, quality, and access. Coined by healthcare economist Paul Kissick, the Iron Triangle suggests that these three dimensions are inextricably linked, such that improvements in one dimension may lead to trade-offs or challenges in the other dimensions. It implies that healthcare systems must strike a delicate balance between containing costs, delivering high-quality care, and ensuring equitable access to healthcare services. Achieving simultaneous improvements across all three dimensions within the Iron Triangle is a complex task, requiring innovative approaches and the integration of technologies such as IoT and AI to drive transformative change.

  1. Cost Efficiency:

Traditionally, healthcare costs have been a major concern for patients, providers, and payers alike. IoT and AI have proven instrumental in streamlining healthcare operations, reducing expenses, and optimizing resource utilization. Here’s how:

a. Predictive Maintenance: IoT-enabled devices and sensors can monitor medical equipment in real-time, allowing for proactive maintenance and minimizing costly breakdowns.

b. Supply Chain Optimization: AI algorithms can analyze historical data to optimize inventory management, reducing waste and ensuring efficient procurement, ultimately driving down costs.

c. Remote Patient Monitoring: IoT devices enable continuous monitoring of patients’ vital signs from the comfort of their homes. This minimizes hospital readmissions, lowers healthcare expenses, and enables early intervention when necessary.

  1. Quality Improvement:

Enhancing healthcare quality is a fundamental objective, and the fusion of IoT and AI has opened up new avenues for achieving this goal. By leveraging real-time data and advanced analytics, healthcare providers can deliver personalized, evidence-based care, leading to improved patient outcomes. Consider the following examples:

a. Precision Medicine: AI algorithms can analyze massive amounts of genomic data to identify personalized treatment options, leading to more effective therapies and tailored healthcare interventions.

b. Decision Support Systems: AI-powered tools assist clinicians by analyzing medical records, lab results, and symptoms to provide accurate diagnoses, recommend treatment plans, and alert providers to potential risks.

c. Patient Safety Monitoring: IoT devices can detect and prevent adverse events such as falls, medication errors, or infections, thereby significantly enhancing patient safety and reducing medical errors.

  1. Access Expansion:

Access to healthcare services remains a persistent challenge in many parts of the world. IoT and AI are actively bridging the gaps by improving healthcare access through innovative solutions. Key examples include:

a. Telemedicine: IoT-powered telehealth platforms connect patients in remote areas to healthcare professionals, eliminating geographical barriers and providing convenient access to care.

b. Wearable Devices: IoT-enabled wearables such as fitness trackers and smartwatches enable individuals to monitor their health parameters, facilitating early detection and prevention of diseases.

c. Virtual Assistants: AI-driven virtual assistants and chatbots can provide basic medical advice, triage patients, and offer 24/7 support, expanding access to healthcare information and guidance.


The combination of IoT and AI has ushered in a new era of possibilities in healthcare. By revolutionizing cost efficiency, quality standards, and access to care within Kissick’s Iron Triangle, these technologies are empowering healthcare systems to meet the ever-evolving needs of patients and providers. As we move forward, continued innovation and integration of IoT and AI will undoubtedly shape a future where healthcare becomes more affordable, higher in quality, and accessible to all.

Remember, the potential of IoT and AI in healthcare is vast, and while challenges remain, their transformative impact is already evident. Embracing these technologies opens up a world of opportunities for improved healthcare outcomes, making the vision of a patient-centric, efficient, and equitable healthcare system a tangible reality.

The Impact of a Debt Default on the Affordable Care Act: Examining Potential Consequences


The Affordable Care Act (ACA), also known as Obamacare, has played a significant role in shaping the healthcare landscape in the United States. However, the potential for a debt default looms large, raising concerns about its impact on various sectors, including healthcare. In this article, we explore how a debt default could potentially affect the ACA and its implementation.

  1. Funding Challenges: The ACA heavily relies on federal funding to support its programs, subsidies, and health insurance marketplaces. In the event of a debt default, the government’s ability to allocate funds effectively may be compromised. This could lead to significant funding challenges for the ACA, potentially hindering its ability to provide subsidies, operate marketplaces, and enforce key provisions.
  2. Reduced Resources: A debt default often brings financial instability, leading to reduced government revenue. In such a scenario, policymakers may face the need to cut spending across various sectors, including healthcare. Consequently, the ACA could experience a reduction in resources and support, making it difficult to sustain and implement its provisions effectively.
  3. Potential Repeal or Amendments: A debt default tends to amplify debates surrounding government spending and fiscal responsibility. This heightened political atmosphere may provide an opportunity for opponents of the ACA to push for its repeal or significant amendments. The ACA’s provisions, coverage expansions, or funding mechanisms could become targets for changes as policymakers navigate the challenges posed by a debt default.
  4. Insurance Market Uncertainty: One of the key achievements of the ACA was the establishment of health insurance marketplaces, providing individuals and small businesses with access to affordable coverage. However, in the event of a debt default, uncertainty may grip the insurance market. This uncertainty could lead to increased volatility, potential disruptions in the availability of health insurance plans, and challenges in maintaining affordable options for consumers.
  5. Impact on Medicaid Expansion: The ACA expanded Medicaid eligibility in many states, allowing more low-income individuals to qualify for coverage. A debt default may prompt debates about the federal government’s role in funding Medicaid, thereby impacting the existing expansion efforts. This uncertainty could create challenges for states that rely on federal funding to sustain or continue the expanded Medicaid coverage.


While the potential consequences of a debt default on the Affordable Care Act (ACA) remain speculative, it’s essential to recognize the possible ramifications it could have on healthcare in the United States. Funding challenges, reduced resources, potential repeal or amendments, insurance market uncertainty, and the impact on Medicaid expansion are some of the areas where the ACA could face significant challenges in the event of a debt default. As the situation unfolds, policymakers and stakeholders must navigate these complexities and prioritize the needs of the healthcare system to ensure the continuity of accessible and affordable care for all Americans.

Disclaimer: The effects discussed in this article are hypothetical and speculative. The actual consequences of a debt default on the ACA will depend on the circumstances and actions taken by the government at the time of the default.

Enhancing the Global Workforce: Reasons Multinational Enterprises Should Offer Group International and Expat Health Coverage


In an interconnected world where businesses transcend geographical boundaries, multinational enterprises (MNEs) play a crucial role in fostering global growth and development. As these organizations expand their operations across countries, it becomes imperative to prioritize the well-being and security of their employees, particularly when it comes to healthcare. Offering comprehensive group international and expat health coverage not only demonstrates a commitment to employee welfare but also provides numerous benefits for both the employees and the organization. In this blog, we will explore the compelling reasons why MNEs should prioritize such coverage and highlight the role of Policy Advantage Insurance Services in facilitating this process by partnering with leading global health insurance companies like Cigna, Allianz, and Anthem GeoBlue.

  1. Duty of Care and Employee Well-being: MNEs have a responsibility to ensure the health and safety of their employees, regardless of their location. By providing group international and expat health coverage, employers demonstrate their commitment to the well-being of their workforce, building trust and loyalty among employees. This coverage extends beyond medical treatment and can include preventive care, wellness programs, mental health support, and emergency assistance, ensuring employees feel valued and supported.
  2. Attracting and Retaining Top Talent: In a competitive job market, offering comprehensive health coverage can be a differentiating factor for attracting and retaining highly skilled employees. Talented professionals seeking international opportunities prioritize benefits such as health coverage for themselves and their families. By providing robust group international and expat health coverage, MNEs position themselves as employers of choice, enhancing their ability to recruit and retain top talent.
  3. Mitigating Health-related Risks: Working in foreign countries can expose employees to unfamiliar healthcare systems, different medical standards, and potential health risks. Group international and expat health coverage offer protection against these risks, ensuring employees have access to quality healthcare services. This coverage can encompass medical evacuation and repatriation, emergency medical assistance, and 24/7 helplines, providing peace of mind to employees and mitigating potential financial and legal risks for the organization.
  4. Enhanced Productivity and Reduced Absenteeism: When employees are worried about their healthcare needs or those of their families, it can significantly impact their productivity and focus. By providing comprehensive health coverage, MNEs help alleviate these concerns, allowing employees to concentrate on their work responsibilities. Additionally, timely access to healthcare services promotes preventive care and early intervention, reducing absenteeism and improving overall productivity.
  5. Compliance with Local Regulations: Many countries have specific requirements regarding the provision of health coverage to employees, including mandatory insurance contributions or coverage levels. By offering group international and expat health coverage, MNEs ensure compliance with local regulations, avoiding potential penalties or legal issues. Policy Advantage Insurance Services, in collaboration with leading global health insurance companies like Cigna, Allianz, and Anthem GeoBlue, helps MNEs navigate these regulations and provides customized solutions to meet their specific needs.


In today’s globalized business landscape, multinational enterprises must prioritize the well-being of their employees, regardless of their geographical location. Offering group international and expat health coverage demonstrates a commitment to employee welfare, attracts and retains top talent, mitigates health-related risks, enhances productivity, and ensures compliance with local regulations. Policy Advantage Insurance Services, through its partnerships with renowned global health insurance companies like Cigna, Allianz, and Anthem GeoBlue, serves as a trusted partner in providing comprehensive coverage solutions that cater to the unique needs of MNEs and their employees. By prioritizing employee health, MNEs can foster a culture of care and support, thereby driving their success in the global marketplace. Connect with us online today. We are a digitally friendly agency and can provide you with information, support, enrollment assistance, and international and expat health coverage for your MNE organization, no-matter where you are in the world. Connecting with a licensed agent and utilizing our international and expat resources and capabilities is just a direct message away. www.PolicyAdvantage.com/Contact 

Navigating the Affordable Care Act’s “Shared Responsibility Provisions” for Employers with +50 FTE


The Affordable Care Act (ACA), often referred to as Obamacare, introduced significant changes to the U.S. healthcare system. Among its various provisions, the ACA established the “Shared Responsibility Provisions” to ensure employers play an active role in providing affordable health insurance coverage to their employees. For businesses with 50 or more full-time equivalent (FTE) employees, understanding and complying with these provisions can be complex and time-consuming. Fortunately, Policy Advantage Insurance Services is here to help employers navigate the intricacies of the ACA and find valuable solutions for their specific needs that create competitive advantage.

Understanding the Shared Responsibility Provisions

Under the Shared Responsibility Provisions, known as the Employer Shared Responsibility Mandate or the “employer mandate,” applicable large employers (ALEs) must meet certain requirements regarding health insurance coverage for their full-time employees.

  1. Applicable Large Employers (ALEs): An ALE is defined as a business with an average of 50 or more full-time equivalent employees during the preceding calendar year. It’s important to note that both full-time and full-time equivalent employees count toward this threshold.
  2. Offer of Minimum Essential Coverage (MEC): ALEs must offer MEC to at least 95% of their full-time employees and their dependents up to age 26. MEC is a basic level of health coverage that meets certain requirements outlined by the ACA.
  3. Affordable Coverage: The coverage offered by ALEs must be affordable, meaning that the employee’s share of the premium for self-only coverage does not exceed a certain percentage of their household income.
  4. Reporting Requirements: ALEs must also fulfill reporting requirements to the Internal Revenue Service (IRS) by providing information about the health coverage they offer to their employees.

Navigating Shared Responsibility Provisions with Policy Advantage Insurance Services

Complying with the ACA’s Shared Responsibility Provisions can be a challenging task for employers. That’s where Policy Advantage Insurance Services comes in. With our expertise and comprehensive knowledge of the ACA regulations, we can assist employers in navigating the complexities of the employer mandate.

  1. Compliance Assessment: Policy Advantage Insurance Services can help employers determine whether they qualify as an ALE and ensure they understand their obligations under the Shared Responsibility Provisions. We can assess your workforce size, evaluate hours worked by employees, and provide clarity on the complex rules and regulations associated with the ACA.
  2. Coverage Analysis: Choosing suitable health insurance coverage for your employees while meeting the affordability standards can be a daunting process. Policy Advantage Insurance Services can analyze various health insurance options available in the market and assist you in selecting plans that meet both your employees’ needs and the requirements of the ACA.
  3. Strategic Partnerships: Policy Advantage Insurance Services has strategic partnerships with various industry leading HR technology companies. These partnerships enhance our capabilities and provide our clients with access to powerful technology that integrates seamlessly with health coverage plans, can help categorize employees, track coverage affordability, prepare compliance forms, and more.
  4. Ongoing Compliance Support: As regulations and requirements evolve, maintaining compliance with the Shared Responsibility Provisions becomes an ongoing task. Policy Advantage Insurance Services can provide continuous support, keeping employers informed about updates, changes, and new compliance requirements.


Navigating the Affordable Care Act’s Shared Responsibility Provisions can be a complex and time-consuming endeavor for employers with 50 or more full-time equivalent employees. However, with the assistance of Policy Advantage Insurance Services, employers can navigate through the intricacies of the employer mandate and ensure compliance with the ACA. By leveraging our expertise, employers can focus on their core business operations, be confident in their ability to provide affordable health insurance coverage to their employees. Connect with us right here online today. www.PolicyAdvantage.com/Contact

Disclaimer: This article provides a general overview of the Affordable Care Act’s Shared Responsibility Provisions for employers with 50 FTE, and is not to be considered legal or tax advice.

PolicyAdvantage.com: Now Officially Property & Casualty Licensed in the State of California

PolicyAdvantage.com is proud to announce that our insurance brokerage firm is now officially licensed to transact Property & Casualty (P&C) lines of insurance in the state of California. With this recent expansion, we’re now offering a full portfolio of products and services across multiple lines of coverage.

Property & Casualty (P&C) insurance includes, but is not limited to:

  • Homeowner’s Insurance
  • Commercial Liability Insurance
  • Commercial Property Insurance
  • Commercial Auto Insurance
  • Business Owner’s Insurance
  • Professional Liability Insurance
  • Pet Insurance
  • Personal Auto Insurance
  • Boatowner’s Insurance
  • RV & Miscellaneous Vehicle Insurance
  • Worker’s Compensation Insurance

One of our primary objectives as an insurance agency is to provide a single point of contact for our customers to conveniently access high quality, affordable insurance policies that fit their budget and coverage necessities— all in one place. With our recent P&C addition, our executive team feels we’ve put ourselves in a strong position to continue to meet this important goal.

Our loyal base of customers in the health insurance and employee benefits space have come to expect reliable, trusted, high quality consultation and service when it comes to their individual, family, or business insurance needs. We’re looking forward to continuing to meet and exceed these high expectations, as we expand into P&C insurance.

Many thanks to those who have worked hard to help us complete our licensing requirements through the California Department of Insurance. Be sure to stay tuned, as we begin to announce the insurance companies, products, and services that will help us continue to put our clients ahead when it comes to their P&C insurance needs. We’re excited to work with you.

PolicyAdvantage.com: Online California eResources

**Take a copy of PolicyAdvantage.com’s California health insurance guide with you, and share it. Download below in .PDF format. Questions? Start a chat with us in lower right, right here at the webpage.



California: welcome aboard. Located in Los Angeles, California, PolicyAdvantage.com is happy to announce that our products and services are available across the entire state. We look forward to working with you.

As your independent insurance agent, we represent you, our client… and help you find the exact policy that fits you best.

Our number one goal is to help individuals, families, small businesses, and large companies maximize the efficiency of their health insurance plans:

  • Improve Coverage
  • Add Flexibility by Offering a Variety of Plan Selections (HMOs, PPOs, etc.)
  • Provide the Most Current Health Insurance Financial Planning Strategies
  • Save Time
  • Save Money
  • Find Your Physician & Hospital Networks
  • Maximize Tax Incentives
  • Find Dental/Vision Plans
  • Provide Direct Access to Expert Licensed Agents
  • …And more.

At PolicyAdvantage.com, we provide a broad range of products and services. We have the capacity to help just about anyone with their health coverage: individuals, families, small businesses, and large companies. Our services are fee-free (ie: premiums are the same, if you work with or without us as your agent). Your single point of contact. All in ONE place.

Products available in California:

  • Individual & Family Plans
  • State Health Insurance Exchange Plans (www.CoveredCA.com)
  • Small Group Health Insurance Plans (for employers of 1-50 employees)
  • Large Group Health Insurance Plans (for employers with 50+ employees)
  • Individual, Family, and Group Dental Plans
  • Individual, Family, and Group Vision Plans
  • Individual, Family, and Group Life Insurance Plans

At PolicyAdvantage.com, we contract with most of California’s leading health insurance companies:

  • Blue Shield of California
  • Kaiser Permanente
  • Oscar Health
  • HealthNet
  • Molina
  • …+Many others.

Additionally, we’re a Covered California Certified Insurance Agency. We are able to help you navigate the state health insurance exchange, where you might be eligible for premium assistance, based on your household size and modified adjusted gross annual income.

Lastly, PolicyAdvantage.com is a “digitally friendly” agency. Just a simple direct message away anywhere online, our clients love our custom-branded ePackets delivered straight to their email. Connect with us online today. Lets start designing and implementing a health coverage program that you, your family, or your company’s employees will love.

Thanks for stopping by, we hope you found our information to be helpful. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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ACA & COVID 19: Boston College “Squared Away Blog” Interviews President of PolicyAdvantage.com Tyson Lester

President of PolicyAdvantage.com Tyson Lester, ChHC®, REBC®, RHU® recently sat down for a one-on-one interview with Kimberly Blanton (former Boston Globe reporter) of the “Squared Away Blog” at the Boston College Center for Retirement Research. Boston College is one of New England’s largest private universities, and is classified as an “R-1” research institution– engaged in the highest levels of research activity. Below is a transcript of the entire interview, and you can link to the official interview at the “Squared Away Blog” right here: ACA Insurance in the Time of COVID-19 (click to visit).

This is a re-blog, and the full interview is a Copyright© of the “Squared Away Blog,” and the Boston College Center for Retirement Research. All rights reserved. You can visit them here:

We hope you enjoy the interview below, and the important information it provides!


The urgency of the pandemic ushered in important changes to the Affordable Care Act (ACA), including a steep reduction in premiums for health insurance policies purchased on the state and federal exchanges through the end of 2022. Now Congress is debating reforms such as making the larger premium subsidies permanent and broadening the reach of the federal-state Medicaid program beyond the expansion introduced in the 2010 ACA.

We spoke with Tyson Lester, an independent insurance agent in southern California, about what the changes so far have meant for consumers. Tyson is licensed to sell policies in California, Florida, and Texas.

Tyson LesterTyson Lester

Has the Affordable Care Act promoted disease prevention and care during the pandemic?

Some of the best feedback we got from our clients was about using the telehealth and remote options in their policies. It’s been an option for quite some time, but it was utilized more frequently during COVID-19. People were able to access primary care physicians, receive consultation and be diagnosed with COVID over the phone. It was amazing. It helped them because: 1) they were able to just make a phone call; 2) they were able to receive good consultation; and 3) if testing was necessary, they were able to go to a testing facility.

In response to COVID, did you see a rush into ACA policies last year?

ACA enrollment increased last year, but consumers’ response to the pandemic was mixed. In 2020, 12 states and Washington D.C. temporarily reopened their health insurance exchanges but people didn’t have the additional premium assistance to make it more affordable. In the remaining states, working people who lacked employer health insurance didn’t have the ACA as another option for coverage when the pandemic hit.

As for the workers who did have employer health insurance last year but then lost their jobs, they had to make a tough decision between whether they wanted to elect their employer’s COBRA, which is expensive, go uninsured, or go on the insurance exchange. But many people weren’t fully aware of the ACA’s longstanding option: when someone loses group health insurance from their employer, they can buy what’s known as a special enrollment ACA plan. In Texas, for example, part of the reason for last year’s increase in the uninsured population, in the midst of COVID-19, was that people who lost their jobs – and their employer coverage – weren’t even aware the ACA exchanges were available to them. We actually put a flyer together for this specific topic last year, because it was so important.

In March, the American Rescue Plan significantly increased the ACA premium subsidies through December 2022. What has been the effect?

For anybody who was previously enrolled, the American Rescue Plan significantly reduced premiums in California, Texas, and Florida and potentially their total out-of-pocket costs. As a result of the larger subsidies, I saw an influx of new customers throughout this year on California’s exchange, which – unlike most other states – opened a special enrollment for all of 2021. Earlier this year, the federal exchange opened, which caused an influx of customers too. This is where Texas, Florida and many other states sell their ACA policies. All states on the federal exchange shut down again in August but will reopen for 2022 in November.

In California, I’m anticipating we’ll see a busy enrollment this fall, because there’s more outreach here than in Texas and Florida. A lot of people are coming to the realization there’s more subsidy available. It takes some time for the general public to realize that. When they first passed healthcare reform, many people didn’t know what the exchanges were or how they worked. When word gets out, you see more people show up and use the premium assistance.

Will people drop their coverage when the federal premium subsidies run out?

It’s hard to say. But if clients see a significant increase in their premiums and can’t afford $200, $300 or $400 more per month, that can be a hit to their household budgets. It’s unfortunate in a pandemic if they would have to drop their health insurance.

Why are the ACA insurance deductibles going up?

The cost of health care and medications increase nearly every year, and the more the insurance companies are able to charge someone on the deductible the less they can charge in premiums. Another way to think about this is that the premiums are increasing at a lower rate than they would if they weren’t also increasing the deductibles.

Have rising costs affected your customers?

Deductibles are high and getting higher, especially for people whose income isn’t low enough to qualify them for the cost-sharing reductions available in some plans sold on the exchanges. But what I have also seen over the past few years is that the insurance companies are redesigning their benefits and making certain medical services more accessible – these are medical services that are not counted against the dollar deductible. That’s a good thing, and it mainly applies to the Bronze or Silver Plans.

For example, in some Silver Plans, the only thing subject to the deductible might be inpatient hospitalizations. Anything else – primary care, X-rays, emergency room visits – aren’t part of the deductible. So, when you go to the primary care doctor or get an X-ray, you might have a $35 copay. For a bigger expense like an outpatient surgery, you can find Silver plans in California where that surgery is not subject to the deductible – so the patient’s cost would be coinsurance only, which is 20 percent of the entire surgery bill, with no deductible having to be paid. These details really matter and determine how much people are spending out of pocket.

The policies offered across the country are standardized – Platinum, Gold, Silver, Bronze – but many hospitals and doctors don’t accept ACA plans. Most doctors accept Medicare. So why is the ACA different?

When they opened the exchanges in 2014, it created an influx of new patients into local health care systems. Those facilities or doctors had to make a determination, based on their caseloads, of whether they would accept the ACA’s negotiated rates for their services and how they would manage that influx. The ACA is mostly HMOs, which reimburse at a lower rate than PPOs. HMOs pay the same amount for every single patient and PPOs pay on a fee-per-service basis. Many established healthcare providers that are in demand have declined to accept individual and family ACA plans. It’s not to say this is always the case, and there is definitely access to quality care within ACA plans. But you want to keep this in mind so you’re making informed decisions when selecting a health plan.

Do the more limited options in the ACA plans affect the quality of care?

Yes, they can. For example, in California, some of the top-notch facilities are tougher to access. In the Los Angeles metro market, for example, a lot of doctors, hospitals, and healthcare facilities won’t accept ACA. UCLA’s medical system, which is No. 1 in California, only accepts one plan – Blue Shield of California’s PPO – on the state’s exchange. Cedars Sinai accepts a limited amount of ACA exchange plans. Texas had a similar thing happen. A good agent should listen to the clients and help them navigate that system.

In addition, the health insurance companies that offer on-exchange plans typically offer fewer plans than they do in the small-group employer market. The way this will be improved is through increased competition among the insurers. But it’s a region-by-region situation. Some places, including Texas and Florida, have seen increases in new plans that are available on the exchange and some areas have seen decreases since ACA’s inception.

Can you explain what it is about each state’s environment – regulations, population size or the insurers operating there – that affects the types of plans and, by extension, the quality of care available in ACA policies?

The exchanges operate the same way whether the customer is in Florida, Texas, or California. When it comes to benefit levels – copays, deductibles, out-of-pocket costs – there’s not much of a difference. The differences often come down to what is convenient for the insurance companies and what the state regulations are. Each insurer has found a niche market in the state they cater to. Where we’re seeing more competition is with smaller companies – names you haven’t heard of like Ambetter and AvMed. Florida Blue and Cigna operate in Florida, but the smaller regional providers are more prevalent in that state.

It’s different in California. Regional insurers like L.A. Care sell policies on the exchange but the big three insurers are the most prevalent: Kaiser Permanente, Blue Shield of California, and Health Net.

What makes California different than, say, Florida?

The variables include population size and regulation. Another big thing in California is that the companies on the exchange have local headquarters and are very familiar with the state’s regulations. California is also more pro-ACA, so it has done things other states have not. For example, they reintroduced an individual mandate [to buy insurance] after it was eliminated at the federal level. So more of the population is going to participate, because there’s a $750 minimum tax for not participating. California initiated a state subsidy too, which is paid on top of the federal subsidy and offsets the costs that consumers pay in premiums.

Residents of Florida and Texas have access to federal premium assistance only. Additionally, Florida and Texas didn’t expand Medicaid so that leaves a lot of poor people out of the health insurance system. To qualify for Medicaid in Florida and Texas, which did not expand their Medicaid programs under the ACA, your income must fall below the poverty level.

But in California, if your income is under 138 percent of poverty, you will be eligible for Medi-Cal, which is the state’s Medicaid. We as agents are trained to cover low-income people in California and agree to help them enroll in Medi-Cal. Medi-Cal and ACA are on the same computer system and are integrated. In Texas and Florida, I don’t know if low-income people are automatically enrolled in Medicaid.

What do you see as the biggest issues for people who buy ACA policies?

The Affordable Care Act really helped a lot of people with guaranteed issue: every plan has to accept people regardless of their health, and the insurers are required to cover 10 essential health benefits, from maternity care to colonoscopies.

Where the law didn’t work very well is for the people who aren’t getting subsidies because they earn too much to qualify for them. Their premiums have gotten very expensive, and they’ve had a hard time with the increases. But I think the biggest issue would be more limited access and narrower networks of doctors and hospitals than the employer plans have.

How might the healthcare exchanges be improved for consumers?

The policies need to be more affordable but that’s a difficult issue to solve, because it would require more government funding to help offset consumers’ costs. For example, the policies aren’t very affordable for people who earn too much to qualify for a subsidy. In California, the combined federal and state subsidies go to people earning up to 600 percent of poverty, but at the top of the range, you get only a very limited subsidy of maybe $10 to $50. If you’re paying $770 for a premium, what’s the difference between paying $800 and $775? The subsidy limit in Florida, Texas and other states that sell on the federal exchange is 400 percent of the poverty level.

One lower-cost option is the short-term insurance plans being sold in Texas and Florida – they’re outlawed in California. In 2017, when Congress repealed the individual mandate, the duration of these short-term, or “skinny,” plans was also extended from three months to three years. People who couldn’t get affordable ACA plans really turned to the skinny plans, which are not sold on the state insurance exchanges. But they don’t have the essential protections required by ACA plans, and you’ve got no guaranteed access if you have a pre-existing condition. The skinny plans may be better than nothing if you’re healthy. But I don’t like them.

Squared Away writer Kim Blanton invites you to follow us on Twitter @SquaredAwayBC. To stay current on our blog, please join our free email list. You’ll receive just one email each week – with links to the two new posts for that week – when you sign up here. This blog is supported by the Center for Retirement Research at Boston College.

The Great Global Lion Debate: Who’s Your Favorite Lion Ever?

It’s our favorite question. President of PolicyAdvantage.com Tyson Lester and our social media team have been asking: who’s YOUR favorite lion ever? And we’ve gotten lots of AWESOME answers from all over the world (posted at the bottom of this blog post).

The lion is the identity of our company — it projects our image to our clients, colleagues, and friends. And, it’s a very universally diverse symbol… most commonly associated with traits like: majesty, royalty, strength, courage, justice, and might.

Additionally, we contribute to www.ProtectingAfricanLions.org (click to visit), a non-profit dedicated to the conservation and protection of the African Lion. Visit their website and pickup a charming, affordable ($21) designer bracelet. They’re hand-made by South African designer jeweler Lianne Landman. A significant portion of proceeds goes directly to protecting the African Lion, whose population has declined 90% in the past 75 years.

So… have you been nominated to join the debate? We’re glad that you’re here, and excited to hear what you’ve got to say. Art lions, sports lions, historical lions, movie lions, royal lions, and many, many more. Join the “great lion debate” community with us today. We’d formally like to ask you: who’s YOUR… favorite lion ever?

(**Editor’s note: if you’re reading this blog post and weren’t nominated on social media, but want to post your favorite lion ever in the comments, please do! We want to hear from you.)

Global Health Coverage: Online Resources

We’re living in a more globally mobile world, and remote work is anticipated to grow exponentially by the year 2030. Individuals, families, and companies are increasingly turning to portable, global health coverage.

For that reason, we’ve put together a suite of global health coverage services for you online here at PolicyAdvantage.com. And the best part about it? You can consult and contact us right here at our webpage.

Your health is one of your most important assets while you’re working abroad. Whether you’re an individual or family, or a company who understands the importance of offering health insurance to your employees… we’ve got you covered. We offer health plans throughout the world:

  • Individual & Family Plans: North America, Europe, Latin America, Asia, MENA (Middle East/North Africa), Africa, Australia, and more.
  • Small Businesses & Corporate Plans: North America, Europe, Latin America, Asia, MENA (Middle East/North Africa), Africa, Australia, and more.

No-matter where you’re from (or where your company is located), we can custom design your international & expat health coverage. Individuals and families can feel confident that they’re covered, and your employees will love the valuable employee benefit if you’re an employer.

We contract with the best international and expat health insurance companies in the industry. Companies that are household names: Cigna Global, Allianz Care, Anthem GeoBlue, IMG Global, and others. Our experts hand-pick your health plan from this portfolio of global health insurance policies based on three distinct characteristics:

  1. Cost. The best priced plans, at the greatest overall value. Many policies only cost a few dollars per day.
  2. Quality of Coverage. Reputable insurance companies, strong networks, and superior plan benefits.
  3. Technology. Easy management of your plan throughout the world on computers and smart phones.

You can feel assured that your health is covered while you’re abroad, in a new place, under new conditions that you might not be use-to. Accidents and sicknesses can happen. In more severe cases (or in cases where there is limited access to proper care locally)… medical evacuations are sometimes necessary. It’s refreshing to know that your health is insured, and that you can concentrate on your day-to-day activities.

Our team has selected plans that provide you with access to medical services in over 200 countries worldwide. These medical networks include thousands of professionals across the globe who provide services like:

  • International Inpatient Care: Surgery & consultation, hospital accommodation, cancer care.
  • International Outpatient Care: Drugs, doctor visits, health & wellness.
  • Medical Evacuation: Evacuation in the event treatment is not available locally.
  • International Vision & Dental: Eye exams; routine and/or major dental treatments.

Connect with us online right here at PolicyAdvantage.com today. We can get you plan information, prices, and put you in contact with a licensed expert who will consult with you, and design your program.

Send us an email from our contact page, or chat with us in the bottom right using our chat feature. It’s easy and convenient to connect. You’ll enjoy peace of mind while you’re covered globally with us… 24/7. 365.