Latest / Get Savvy...Demystifying Healthcare / Episode 149: Your Doctors, Your Prescriptions, Your Budget: Choosing Health Coverage

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Episode 149: Your Doctors, Your Prescriptions, Your Budget: Choosing Health Coverage · Get Savvy...Demystifying Healthcare

• 0:00
  SPEAKER_00: It's an excellent question because people don't realize, uh, particularly on silver plans, that uh they'll pay 10, 15, 20% more for a silver plan uh if they're not getting a tax credit.
• 0:11
  SPEAKER_00: Uh and so they're much better off off exchange on those plans.
• 0:15
  SPEAKER_00: And there's also um there's a new thing called ICRAS, which the employees can pick individual plans and then they can uh the employer can pay for part or all of it, and it's uh whatever part the employee pays is pre-taxed.
• 0:31
  SPEAKER_02: If healthcare has ever left you feeling frustrated, overwhelmed, or stuffed, this show is for you.
• 0:37
  SPEAKER_02: Welcome to Get Davvy, the mystified healthcare weekly podcast, where we take complicated healthcare topics and mix them topics for experts and real world strategies, complex health care, the lower infrastructure costs, the data advocacy and the latest healthcare tests.
• 0:57
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• 1:07
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• 1:10
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• 1:15
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• 1:21
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• 1:26
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• 1:35
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• 1:37
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• 1:51
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• 1:56
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• 2:00
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• 2:20
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• 2:46
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• 2:52
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• 2:55
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• 3:01
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• 3:12
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• 3:37
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• 3:45
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• 3:56
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• 3:58
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• 4:03
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• 4:07
  SPEAKER_03: And now on with the show.
• 4:10
  SPEAKER_03: Well, hello everyone, and welcome to the show Health Insurance Premiums Up, Coverage Down, What to Ask Before You Enroll.
• 4:16
  SPEAKER_03: Does shopping for health insurance feel like the same frustrating puzzle every year?
• 4:21
  SPEAKER_03: Premiums go up, deductibles climb, and you're left wondering, am I paying more for less?
• 4:26
  SPEAKER_03: And how do I know which plan is actually right for my family?
• 4:30
  SPEAKER_03: Today we're talking through the questions for individuals and families and what to consider and the questions to ask during open enrollment to make the best decision that fits care needed and your budget.
• 4:42
  SPEAKER_03: To help us get into this topic, I have Tom Crenin on the show.
• 4:45
  SPEAKER_03: Tom is a licensed insurance agent in health, life, property, and casualty, and he's a registered professional engineer as well.
• 4:53
  SPEAKER_03: Tom founded Colorado Health.com Inc.
• 4:56
  SPEAKER_03: in 1996.
• 4:57
  SPEAKER_03: So he has 30 years experience in the business.
• 5:00
  SPEAKER_03: Tom and his colleagues work hard to stay ahead and keep the agency being one of the best in the industry.
• 5:06
  SPEAKER_03: Welcome to the show, Tom.
• 5:08
  SPEAKER_01: Well, thank you very much, Sandy.
• 5:10
  SPEAKER_03: Well, let's get started.
• 5:11
  SPEAKER_03: You have 30 years in the business.
• 5:13
  SPEAKER_03: Tell us more about you and how it's led you to doing all the great things you're doing today.
• 5:18
  SPEAKER_01: Well, it's an interesting path.
• 5:20
  SPEAKER_01: I I grew up in uh Denver, Colorado.
• 5:22
  SPEAKER_01: My dad was an insurance agent, uh, mostly auto and home and commercial insurance.
• 5:27
  SPEAKER_01: And then I went to school as an engineer.
• 5:29
  SPEAKER_01: I was a petroleum engineer for like 20 years with kind of quite a bit of programming in it.
• 5:35
  SPEAKER_01: It came, this was 30 years ago.
• 5:37
  SPEAKER_01: I kind of had the choice of either going to Houston and continuing my job or staying here in Denver, and I decided to stay in Denver, went to work for my brother, who had taken over my dad's business, and uh decided uh made the first instant quoting health insurance website uh back in 1996.
• 5:54
  SPEAKER_01: The internet was pretty new.
• 5:55
  SPEAKER_01: I actually did the programming and built the website so people could go on and uh get health insurance quotes for themselves uh kind of on the spot.
• 6:04
  SPEAKER_01: And that kind of launched the company, Colorado Health.com, and uh had built it up since then.
• 6:09
  SPEAKER_01: We also do something called ICO administration now.
• 6:12
  SPEAKER_01: But uh basically we've been doing it for a while and it's it's been fun.
• 6:16
  SPEAKER_01: Uh the health insurance, kind of like your title says, is interesting.
• 6:19
  SPEAKER_01: It uh certainly has been getting more expensive, and the deductibles get higher, so it's it's an interesting business, yeah, on things.
• 6:26
  SPEAKER_01: And the cost we have uh I've covered, you know, accidents and things has gone extremely high also.
• 6:32
  SPEAKER_03: But well, and I never mean to be negative by any means.
• 6:35
  SPEAKER_03: I always try to be factual.
• 6:37
  SPEAKER_03: And I think it's top of mind is is there a lot of legislature changes and a lot of things going on at the moment.
• 6:43
  SPEAKER_03: But we are coming up at the time of this recording on the 2027 enrollment period for individuals and families.
• 6:50
  SPEAKER_03: I acknowledge that some things probably can't be shared yet, but what are some highlights that you can share that of maybe some upcoming changes that consumers really need to be on the lookout for as they prepare to evaluate their plans and perhaps get a new one?
• 7:07
  SPEAKER_01: So I know we do mostly Colorado health insurance.
• 7:10
  SPEAKER_01: So I know that's limiting your audience a little bit, but at least I'll give you a view of what Colorado looks like.
• 7:14
  SPEAKER_01: Uh so we do have the 2027 rates have been filed, and it's been kind of an interesting mix.
• 7:20
  SPEAKER_01: Here in Colorado, we have six different carriers.
• 7:22
  SPEAKER_01: We had one carrier leave, which is uh kind of a national to insignia health insurance, which has individual policies across the United States, has left the market.
• 7:31
  SPEAKER_01: They're not going to do individual policies anymore anywhere in the United States.
• 7:35
  SPEAKER_01: And so they left.
• 7:37
  SPEAKER_01: We have a new carrier called Colorado Access that is joining the market.
• 7:40
  SPEAKER_01: So we still have six carriers.
• 7:41
  SPEAKER_01: That is good.
• 7:42
  SPEAKER_01: Uh Kaiser has come in for 2027 as the lowest priced carrier.
• 7:47
  SPEAKER_01: So that's what they've always been on the lower price side, but now they're kind of on the lowest priced.
• 7:52
  SPEAKER_01: We've seen some other Anthem is still pretty competitive.
• 7:55
  SPEAKER_01: They had about a 10% increase.
• 7:57
  SPEAKER_01: Kaiser had about a 9.5% increase.
• 8:01
  SPEAKER_01: Some other ones like uh Select Health, which is a somewhat newer carrier, had a had a little higher increase, but they were amongst the lowest last year.
• 8:09
  SPEAKER_01: So it all is kind of bounced out.
• 8:11
  SPEAKER_01: But you know, big picture is we still have six carriers.
• 8:14
  SPEAKER_01: They've changed a little bit.
• 8:15
  SPEAKER_01: Prices on average maybe went up 12 or 15 percent if you look at it.
• 8:19
  SPEAKER_01: The tax credits associated with individual plans on the Obamacare ACA also went up.
• 8:24
  SPEAKER_01: So a lot of people that were getting a tax credit will still look about the same in 2027 as they did in 2026.
• 8:30
  SPEAKER_01: It won't be wildly different than it was before.
• 8:33
  SPEAKER_01: It's kind of a big picture view of things.
• 8:36
  SPEAKER_03: Yeah, no, I appreciate that.
• 8:38
  SPEAKER_03: And speaking of that, let's talk about one of the questions I hear people ask is certainly buying on the exchange versus off the exchange.
• 8:46
  SPEAKER_03: And just if for some it may be a refresher, but for some, they're probably saying, thank God she asked that question because I've always wanted to know.
• 8:54
  SPEAKER_03: Can you help people understand?
• 8:56
  SPEAKER_03: Because there really are two options.
• 8:57
  SPEAKER_03: They can buy on the exchange, the state exchange created by the ACA, or they can buy off the exchange.
• 9:04
  SPEAKER_03: What is really the difference and when should they go one direction or the other?
• 9:09
  SPEAKER_01: So that's a super big, huge change here in Colorado for 2027.
• 9:13
  SPEAKER_01: So Colorado is not a federal exchange called FFM.
• 9:16
  SPEAKER_01: Most the majority of states are FFM.
• 9:19
  SPEAKER_01: Uh the remainder of the states have what are called state exchanges.
• 9:22
  SPEAKER_01: Colorado has a state exchange and they can run by a little bit different rules.
• 9:25
  SPEAKER_01: They get to create their own rules.
• 9:27
  SPEAKER_01: This year, for the first time ever, they're going to actually start quoting plans that are both on the exchange where you can get a tax credit, and plans that are off the exchange, uh, where sometimes there are more plan options and lower prices.
• 9:40
  SPEAKER_01: So if you're not getting a tax credit, the silver plans in particular tend to be lower priced uh off exchange.
• 9:46
  SPEAKER_01: So we've always quoted both uh on ours, and we try to put people in the right spot.
• 9:51
  SPEAKER_01: But it's an excellent question because people don't realize, uh, particularly on silver plans, that uh they'll pay 10, 15, 20% more for a silver plan if they're not getting a tax credit, uh, and so they're much better off off exchange on those plans.
• 10:06
  SPEAKER_01: And there's also uh there's a new thing called ICRAs where employees can pick individual plans and then they can uh the employer can pay for part or all of it, and it's uh whatever part the employee pays is pre-taxed.
• 10:18
  SPEAKER_01: So it ends up being uh basically a replacement for traditional group health insurance, and carriers have been kind of embracing that.
• 10:26
  SPEAKER_01: They've been making new plans off exchange because ICRAs are mostly done off exchange.
• 10:30
  SPEAKER_01: Uh so there's actually more plan choices off exchange than the on exchange.
• 10:35
  SPEAKER_01: So it's a little bit of a complicated field.
• 10:37
  SPEAKER_01: Yeah, you've got the tax credits when you go on exchange, and now there's limits.
• 10:41
  SPEAKER_01: There's this uh 400% federal property level if you're above that.
• 10:46
  SPEAKER_01: So a single person, right around$62,000,$63,000.
• 10:50
  SPEAKER_01: If they make more than that, they will not get a tax credit.
• 10:53
  SPEAKER_01: If they make under that, then they probably will get a tax credit depending on how old they are.
• 10:58
  SPEAKER_01: It goes up a little bit to$84,000 if it's a married couple and things like that.
• 11:03
  SPEAKER_01: But so there's income limits, gross income limits, where if you fall underneath those, you can get a tax credit, and those plans you definitely need to buy on the exchange.
• 11:13
  SPEAKER_01: Those plans also qualify if you're really low, you have to make uh about 20 above 22,000 in order to even otherwise you've got to Medicaid.
• 11:22
  SPEAKER_01: But if you make, you know, 24,000, you'll get not only a great tax credit, but you can get an improved silver plan.
• 11:29
  SPEAKER_01: So they're they're called costal reductions.
• 11:32
  SPEAKER_01: So when you are on the lower end of the income, you're actually better off on a silver plan on exchange.
• 11:38
  SPEAKER_01: If you're not getting a tax credit, you're better off off the exchange.
• 11:43
  SPEAKER_01: So yeah, lots lots going on there on that side.
• 11:46
  SPEAKER_03: Yeah.
• 11:46
  SPEAKER_03: Now those numbers that you quoted, is that Colorado specific uh only?
• 11:51
  SPEAKER_01: Or is it those those numbers are actually uh pretty much nationwide?
• 11:54
  SPEAKER_01: I think there may be some difference uh for I think Alaska has slightly different numbers, but for the contiguous 48 states, I know those numbers are all the same.
• 12:03
  unknown: Yeah.
• 12:04
  SPEAKER_03: Good to know.
• 12:05
  SPEAKER_03: So if if I can think about this, if you're one of my listeners and you're at a red light, you're like, wow, Tom said a lot of stuff.
• 12:11
  SPEAKER_03: How the heck am I supposed to manage or navigate this?
• 12:14
  SPEAKER_03: So with that, I often say you don't have to do it alone.
• 12:17
  SPEAKER_03: What is the power of working with a broker?
• 12:20
  SPEAKER_03: We hear the word agent, we kind of use those universally sometimes.
• 12:24
  SPEAKER_03: But what it what is the power of working with a broker and how much does it cost the consumer?
• 12:30
  SPEAKER_01: Yeah.
• 12:31
  SPEAKER_01: So the first thing is that traditionally brokers uh are no no cost to the member.
• 12:36
  SPEAKER_01: So brokers do get paid a commission.
• 12:38
  SPEAKER_01: They actually have to disclose that commission.
• 12:40
  SPEAKER_01: It's pretty low.
• 12:41
  SPEAKER_01: I will say in Colorado, on average, a broker will make somewhere between$18 and$20 per member per month.
• 12:48
  SPEAKER_01: So if you sign up with them, they'll make say$240 a year off of it.
• 12:53
  SPEAKER_01: That commission uh for the year is paid for by the carrier.
• 12:57
  SPEAKER_01: And it's the same whether you buy it to an agent or you don't buy it to the agent.
• 13:01
  SPEAKER_01: The premium's gonna be the same either way you do it.
• 13:03
  SPEAKER_01: So I guess my feeling is get a good broker, uh, who knows what they're doing, and they will uh I think they'll really help you out because there's a lot of trickiness in the navigation of the system.
• 13:14
  SPEAKER_01: There's some things you can do that was kind of new recently, just I believe last year.
• 13:18
  SPEAKER_01: They made all the bronze plans on the individual ACA market are now HSA compatible.
• 13:25
  SPEAKER_01: So if you buy a bronze plan, let's say you're real close to that, you know,$65,000 number and you want to get that down to$62, you can buy a bronze plan that is HSA qualified, put$3,000 into your HSA account.
• 13:39
  SPEAKER_01: Then that$3,000 comes off your income.
• 13:42
  SPEAKER_01: You now qualify for the tax credit.
• 13:44
  SPEAKER_01: So you get$3,000 in the HSA that you put in there, and you get this, you know, sometimes very large tax credit depending on your age.
• 13:51
  SPEAKER_01: There's a lot of tricky things you can do that will really help a person out when you kind of understand them on that.
• 13:58
  SPEAKER_03: I'm gonna summarize that because I think there are two key things for people to listen to where they can benefit.
• 14:03
  SPEAKER_03: Number one, it doesn't cost the consumer anything to work with a broker.
• 14:07
  SPEAKER_03: Number two, a broker's gonna have that advantage, but you're also getting additional training.
• 14:12
  SPEAKER_03: So all of these things that you're talking about are things that you can seek to understand that person who you're working with, and then based on what you know in the industry, can find the right fit for them and and help answer those questions and navigate the maze of care.
• 14:28
  SPEAKER_01: Definitely.
• 14:29
  SPEAKER_01: And then the other big thing that people really like to keep is their doctors.
• 14:33
  SPEAKER_01: So when you're going out there searching a plan, people will have a particular doctor, not always, but sometimes they'll have a doctor that they want to keep, sometimes it's a specialist.
• 14:41
  SPEAKER_01: And so having the ability to look at all these different plans.
• 14:45
  SPEAKER_01: So there's six different carriers uh in Colorado, and then each one of those carriers is some of my have as many as 10 plans per metal level.
• 14:55
  SPEAKER_01: So they'll have like 30 plans.
• 14:56
  SPEAKER_01: So you you can end up with this huge array of plans.
• 14:59
  SPEAKER_01: So you want to narrow down on finding a plan that has your doctorate if that's important to you.
• 15:04
  SPEAKER_01: And then you have quite a large choice of plans to look at.
• 15:08
  SPEAKER_01: If I had to simplify, there's the bonds plans, the higher deductible, they're HSA qualified, and you're gonna pay less premium for them, but you're gonna have more upfront costs with them.
• 15:20
  SPEAKER_01: The silver plans are kind of in between.
• 15:21
  SPEAKER_01: They're probably gonna have a uh a drug card with a copay on it.
• 15:25
  SPEAKER_01: They may they're gonna have deductibles in the range of maybe three to five thousand dollars, and uh, they're the in-between plan, and then there's the gold plans that they vary a bunch, but they'll have deductibles from$2,500 down to zero and have a bunch of co-pays for things.
• 15:41
  SPEAKER_01: Uh so there's really a wide range.
• 15:43
  SPEAKER_01: If certainly if you have something going on, a lot of times people will go with the better gold plan, so they just have to pay more co-pays.
• 15:50
  SPEAKER_01: They don't have as big as financial exposure if something happens to them.
• 15:53
  SPEAKER_01: If people are uh you know, pretty dog on healthy, a lot of times they'll go with the bronze plan.
• 15:58
  SPEAKER_01: The savings in the premium, they think that, well, over time I'll save enough on the premium that I can pay for that debt every now and then.
• 16:04
  SPEAKER_01: So those are the kind of big picture thoughts that yeah that people have on this stuff.
• 16:11
  SPEAKER_03: Well, what would you tell consumers, and let's focus on the individual family for a moment.
• 16:14
  SPEAKER_03: What would you tell folks listening?
• 16:16
  SPEAKER_03: Is there maybe three things that they can do to prepare for open enrollment, uh, that to help work with a broker to kind of have that village approach to can get the best solution?
• 16:26
  SPEAKER_03: What are three things that they can do to prepare?
• 16:31
  SPEAKER_01: Knowledge is always the best thing.
• 16:32
  SPEAKER_01: And so I'm a broker, so I'm gonna tell you I'm a good broker and uh work with them.
• 16:37
  SPEAKER_01: I think would be a great thing.
• 16:38
  SPEAKER_01: I would say it, you know, you can kind of tell what's going on with the broker.
• 16:42
  SPEAKER_01: If you if you say, hey, I need these doctors, and you look up the doctors and uh things kind of, you know, make sense to you and uh the various things.
• 16:49
  SPEAKER_01: Know that the agents don't make any more commission by selling an expensive plan or a cheap plan, or one with a tax credit or without tax credit.
• 16:57
  SPEAKER_01: Their commission is the same no matter what.
• 16:59
  SPEAKER_01: So there's no advantage to them to try to sell you an expensive plan versus a less expensive plan.
• 17:04
  SPEAKER_01: So I don't I would work with a a good agent.
• 17:07
  SPEAKER_01: If you're shopping on the market, it's good to understand basically understanding the intricacies of how tax credits work.
• 17:14
  SPEAKER_01: Uh those are real tricky.
• 17:16
  SPEAKER_01: I'll just go back to the example of maybe the person making sixty-two thousand dollars who uh is getting a decent, let's say they're 50 years old and that's$62,000, they're probably gonna be getting a tax credit in the range of$400 a month.
• 17:29
  SPEAKER_01: And all of a sudden they find out that uh they got an inheritance or something, and uh they made an extra$10,000 that year.
• 17:38
  SPEAKER_01: So all of a sudden they made$72,000 instead of$62,000.
• 17:42
  SPEAKER_01: That$400 a month tax credit they made, they're gonna have to pay that back at the end of the year when they do their taxes.
• 17:48
  SPEAKER_01: So that's the other thing that a lot of people, you know, kind of need to understand is that, yeah, these tax credits are fantastic, but if you make more money than this$400 uh federal property limit cliff, then you have to pay all those tax credits back on clinics.
• 18:03
  SPEAKER_03: Yeah, definitely don't want to do that.
• 18:04
  SPEAKER_03: I think it supports the the power of the broker.
• 18:07
  SPEAKER_03: And I have to throw this in there.
• 18:08
  SPEAKER_03: So I am no longer a broker, as as you know, but I remember back in the day, and I remember talking to someone, so I have to bring it up because AI is top of mind.
• 18:17
  SPEAKER_03: And a lot of individuals and families do like to do things themselves, but I I would say for those who wanting to put things in your AI tool of choice, you're likely going to get back generic answers and not specific to Colorado.
• 18:29
  SPEAKER_03: So trust but verify and make sure and work with a broker.
• 18:33
  SPEAKER_03: Because I mean, like I said, just hearing you talk about all these things, Tom, is just uh amazing and a wealth of information.
• 18:38
  SPEAKER_03: Then they're not gonna get specifically throwing something in a chat GPT.
• 18:43
  SPEAKER_03: So I have to throw that out there as well to be cautious of that.
• 18:47
  SPEAKER_01: Yeah, I definitely like AI LSO, but you do have to kind of write the ask the right questions.
• 18:52
  SPEAKER_01: I mean, you'll get answers back, but it won't tell you that, oh, if you go over this amount, you have to pay it all back and things like that.
• 18:58
  SPEAKER_03: Yeah.
• 18:59
  SPEAKER_03: Yeah.
• 18:59
  SPEAKER_03: Definitely.
• 19:00
  SPEAKER_03: Well, let's switch gears for just a moment.
• 19:02
  SPEAKER_03: I want to talk about and meet the needs of, because we think of individuals and families, and some do get their care from a small employer.
• 19:10
  SPEAKER_03: And, you know, small employer groups are working hard to try to provide solutions.
• 19:15
  SPEAKER_03: You mentioned ICRA and small employer groups.
• 19:17
  SPEAKER_03: What would you say to that audience or that small employee person listening?
• 19:22
  SPEAKER_03: Uh, what is ICRA and what's on the horizon for those employer groups trying to help their employees get the care they deserve?
• 19:31
  SPEAKER_01: So uh ICRAs are fairly new.
• 19:33
  SPEAKER_01: They were uh the legislation was done in 2019.
• 19:36
  SPEAKER_01: They started in 2020.
• 19:38
  SPEAKER_01: And so the idea behind it is that ICRA is uh an acronym for individual coverage health reimbursement arrangement.
• 19:46
  SPEAKER_01: So HRA is it can be used for different things, but so it's individual coverage HRA.
• 19:51
  SPEAKER_01: And so there's a bunch of rules and regulations on how they work.
• 19:55
  SPEAKER_01: But fundamentally, what they say is that an employer can put an ICRA into place, the employees can go out and pick any individual plan that's available to them in that area, and then the employer will set a contribution that's saying it can vary by age, so older people can get more money than younger people, but it if the same age person has to get the the same amount of contribution from the employer.
• 20:18
  SPEAKER_01: And so there's platforms out there.
• 20:20
  SPEAKER_01: I mean, we have one, uh Equosystems, that will allow you to go and the employees to look at all their plan choices and they'll say, hey, these are all my plan choices, and this is how much the employer is paying for them.
• 20:32
  SPEAKER_01: I can pick any plan I want.
• 20:34
  SPEAKER_01: Uh here in Colorado, you know, Kaiser, uh not to be hard on Kaiser, but people either kind of love or hate Kaiser.
• 20:40
  SPEAKER_01: So some people are, you know, really happy to have the Kaiser option, and other people are really happy to pick a different option where they maybe can keep the doctor they have now.
• 20:48
  SPEAKER_01: And so it allows for a lot of choice.
• 20:51
  SPEAKER_01: So the choice is huge.
• 20:53
  SPEAKER_01: And then the other thing that's going on, not in every state, but in about a third of the states, uh the individual policies are less expensive than the group policies.
• 21:02
  SPEAKER_01: And so for that reason, employers, Colorado's one of the states where the uh individual rates are generally less than the individual, but then the group rates.
• 21:11
  SPEAKER_01: So not only can the employer allow the employees to have choice on what plan they want, so they kind of get out of that mix, but they can also have the ability to just contribute a fixed amount of money and they don't have to worry about picking the choice, and they'll save money overall because the overall cost is less for the plans.
• 21:29
  SPEAKER_03: Well, that sounds interesting.
• 21:30
  SPEAKER_03: Well, I the I didn't know that about the groups, but I I know a lot of small business owners being one myself, and I'm sure you do in your circles as well.
• 21:38
  SPEAKER_03: But yeah, it it's hard when you have employees and you're really trying to do the best that you can.
• 21:42
  SPEAKER_03: But I think it's so important to know options.
• 21:44
  SPEAKER_03: Well, speaking of that, tell us more about Colorado Health, the people that you serve, the services you offered.
• 21:51
  SPEAKER_03: What can can people expect when they reach out to Colorado Health?
• 21:55
  SPEAKER_01: Well, we were we were started in 1996, so we did have really been doing it for 30 years.
• 22:00
  SPEAKER_01: We do basically three things.
• 22:01
  SPEAKER_01: So we certainly do individual uh health insurance both on the exchange and off the exchange with and without tax credits.
• 22:08
  SPEAKER_01: So we do that.
• 22:08
  SPEAKER_01: We do Medicare, which is people aging a typically age sixty-five, uh they'll age into Medicare.
• 22:15
  SPEAKER_01: So there's all kinds of different choices with Medicare, so we do that.
• 22:19
  SPEAKER_01: And then we do group insurance, which is group health insurance, which is insurance for employers who want to offer coverage to their employees, uh, basically.
• 22:27
  SPEAKER_01: So those are the three things we do.
• 22:29
  SPEAKER_01: And there's some ancillary things like that, like uh, you know, dental insurance and stuff that kind of go along with it.
• 22:36
  SPEAKER_03: Awesome.
• 22:36
  SPEAKER_03: So and that does lead me to one other then.
• 22:38
  SPEAKER_03: So if someone says they're hearing a lot about hospital indemnity or maybe they're looking for a cancer plan or something of the sort, you guys can help support in that area too.
• 22:48
  SPEAKER_01: Yeah, that that that's an interesting field.
• 22:51
  SPEAKER_01: Some agents definitely are more proactive on it than than others.
• 22:55
  SPEAKER_01: There's definitely a feeling out there uh for some people that you maybe you get a bronze plan and then you get a hospital indemnity or an accident policy to go along with it to cover things when they happen.
• 23:07
  SPEAKER_01: Uh some people say, well, I'll just get a better plan and do it that way.
• 23:12
  SPEAKER_01: There's pluses and minuses to both.
• 23:13
  SPEAKER_01: The the indemnity plans work great when things happen, but there's a lot of particular things that they have to fit in order for them to pay out.
• 23:21
  SPEAKER_01: Whereas when you're buying the general health insurance, even if it's not an accident, it will still cut on you on things like that.
• 23:27
  SPEAKER_01: So that's there's kind of two sides to those, but those definitely are popular with some agents more than others, and there's definitely strategies around those.
• 23:36
  SPEAKER_03: Well, and I what I like talking with you about, Tom, is that you really take the road of really uh looking at the person in their situation.
• 23:43
  SPEAKER_03: I love your thoughts on a strategy and approach.
• 23:46
  SPEAKER_03: You and your team are trying to do the best for what that person or that family's health needs, our employer group, as it were, as well.
• 23:53
  SPEAKER_03: So I really appreciate that about you.
• 23:55
  SPEAKER_03: We will make sure and link to Colorado Health so people can reach out to you.
• 24:00
  SPEAKER_03: Now, let me ask you, let's say for the the folks that may be listening in Arizona or Utah, but they're like, gosh, I really like like Tom.
• 24:07
  SPEAKER_03: I mean, are do you only serve Colorado or what if someone reaches out?
• 24:11
  SPEAKER_03: Can you direct them if you can't support that state?
• 24:14
  SPEAKER_03: How does that work?
• 24:16
  SPEAKER_01: We do do just Colorado primarily.
• 24:19
  SPEAKER_01: Uh with the ICRA business, we help people in other states, but generally on the individual side, we just do Colorado.
• 24:25
  SPEAKER_01: I would say, you know, you can go to healthcare.gov, that's the main website for the ACA Obamacare policies.
• 24:32
  SPEAKER_01: They will direct you to the state you're in.
• 24:34
  SPEAKER_01: And so some have state exchanges, some are done on the FFM, the federal marketplace.
• 24:40
  SPEAKER_01: There's been a little bit of fraud going on on the FFM, and uh they have been kind of cracking down on there's a little little bit of a trend.
• 24:49
  SPEAKER_01: So they used to allow with tax credits, you could end up with a zero premium policy, uh, so you wouldn't have to pay anything for it.
• 24:56
  SPEAKER_01: It makes sense.
• 24:56
  SPEAKER_01: If you picked a policy and you had a tax credit and pay anything for it, there was potentially some fraud out there where they were just dinging up a lot of policies that had zero premium and there weren't real people behind those.
• 25:08
  SPEAKER_01: And uh so that was they're trying to certainly crack down on that.
• 25:11
  SPEAKER_01: That happened more on the federal marketplace.
• 25:13
  SPEAKER_01: Colorado has been fairly immune to that.
• 25:15
  SPEAKER_01: Uh we just haven't seen that level of corruption, which is which is nice.
• 25:19
  SPEAKER_01: So a little bit of that's going on.
• 25:21
  SPEAKER_01: I would say most of those sites will have reg certified brokers that are on there.
• 25:27
  SPEAKER_01: You can look them up for that stake.
• 25:29
  SPEAKER_01: And then you can always just go on the the internet and you know look at people.
• 25:34
  SPEAKER_01: The one thing I guess I would suggest not doing that I hear people do that is you will find websites on the internet and say, hey, we'll find you an agent.
• 25:42
  SPEAKER_01: And what they do is you'll put your name and phone number in there, and then they'll sell that out to a whole bunch of agents, and uh they will go and you know, just bombard people with, you know, they'll get 20 different phone calls from all these leads that they got.
• 25:56
  SPEAKER_01: I I would say if you can find a particular agent where you actually know it's a real agency with a real person, I just think you're gonna be way better off doing that than putting your information in.
• 26:07
  SPEAKER_01: I'd be very literally putting my information in and you know getting bombarded by a whole bunch of uh, you know, people calling you.
• 26:14
  SPEAKER_01: I I I'm a little hard on it, but I'm not a real fan of the boiler looms.
• 26:17
  SPEAKER_01: There are there are kind of people or groups out there that just try to sell insurance to everybody all across the United States.
• 26:24
  SPEAKER_01: And if it's just too hard for an agent to know all the doctors and know all the intricacies of the plans for every state.
• 26:31
  SPEAKER_01: I think you're much better getting a broker that's local in that area who knows the plans there.
• 26:37
  SPEAKER_01: And I think I think they'll have a better experience with it.
• 26:40
  SPEAKER_01: Oh, yeah.
• 26:40
  SPEAKER_03: Definitely.
• 26:41
  SPEAKER_03: No, I appreciate that.
• 26:42
  SPEAKER_03: Well, as we get to a wrap, uh what are some final tips that you would leave individual families, caregivers, of of uh family members, and or small employer groups?
• 26:52
  SPEAKER_03: What what are some final uh thoughts that you would give them as we approach the open enrollment for 2027?
• 26:59
  SPEAKER_01: It's it's a little bit of a complicated feel, so I definitely would say get a good broker.
• 27:03
  SPEAKER_01: I'll just give you some big pictures things that are going on with big pictures.
• 27:07
  SPEAKER_01: Uh there's been a lot of people that have been on Medicaid that maybe shouldn't have been on Medicaid, so we're expecting to see a lot of Medicaid people roll off.
• 27:14
  SPEAKER_01: So we're going to see influx of people into the market.
• 27:18
  SPEAKER_01: There's something called CHP Plus, and I believe that's a federal program, but uh certainly here in Colorado.
• 27:24
  SPEAKER_01: So if you're a family and you make under 260% federal property limit, then children that are 18 or under, so 260% of federal property limit, I don't know that one right off the bat, but I'm guessing that that one's maybe a you know a mother and child in the you know$45,000 range would still probably be under uh$260 for the child.
• 27:46
  SPEAKER_01: So the child who is 18 and under can go to CHP plus.
• 27:50
  SPEAKER_01: The mother can have her own ACA policy on that.
• 27:53
  SPEAKER_01: There's just a lot of things that can be done that can really help people out, I think, on that.
• 27:59
  SPEAKER_01: And then be aware that if you do make more money, you're gonna have to pay back all the tax credits.
• 28:04
  SPEAKER_01: And uh some of the minor plan that has the doctor that you want.
• 28:07
  SPEAKER_01: Some people are very uh medicine, kind of RX sensitive.
• 28:10
  SPEAKER_01: So if they're taking a specific medicine, you know, take a look at the plan that works best for you.
• 28:16
  SPEAKER_01: It is interesting that the ACA plans include drug costs into their overall max out of pocket.
• 28:21
  SPEAKER_01: So if you do happen to get hit with some super expensive medication, it will go to your max out of pocket and then it will stop after you hit your max out of pocket.
• 28:29
  SPEAKER_01: Quite a bit of protection, but the max out of pockets are pretty high.
• 28:32
  SPEAKER_01: They're you know, eight to ten thousand dollars on a lot of plans.
• 28:35
  SPEAKER_01: So those can be bought down with cost share reduction.
• 28:39
  SPEAKER_01: So if you are close to that just or I don't know, if you're making, you know, j just over uh say$24,000 or so as a single person, uh, you're gonna see these cost share reduction silver plans, and they are gonna have crazy low deductibles and crazy low max out of pockets.
• 28:58
  SPEAKER_01: So there's a lots of things, and those don't have to be paid back if you uh if you make more money so you end up getting some money and you you know don't get the tax trade, you don't have to pay back the extra of the lower deductibles and lower max out of pockets.
• 29:12
  SPEAKER_03: Well, Tom, you have such a great wealth of expertise and and I know you have a team of people as well.
• 29:17
  SPEAKER_03: So I cannot thank you enough for taking time.
• 29:20
  SPEAKER_03: Glad we caught you before the whirlwind of activity starts up.
• 29:23
  SPEAKER_03: But I really appreciate you taking the time.
• 29:25
  SPEAKER_03: You've really kind of put to light in my mind the importance of working with someone uh to really help you navigate and get the the best best option.
• 29:33
  SPEAKER_03: So again, we'll we'll link to Colorado Health.
• 29:36
  SPEAKER_03: Thank you again uh for your time and expertise.
• 29:38
  SPEAKER_03: So we really appreciate it.
• 29:40
  SPEAKER_01: Okay, thanks, Sandy.
• 29:42
  SPEAKER_01: Appreciate it.
• 29:42
  SPEAKER_01: All right.
• 29:44
  SPEAKER_03: What a wealth of information to absorb.
• 29:47
  SPEAKER_03: And if you're still trying to digest some of that and you have some questions, make sure and check out the link to Colorado Health below.
• 29:54
  SPEAKER_03: Tom and his team, when I say this, are absolutely amazing.
• 29:58
  SPEAKER_03: And as a former broker, I cannot tell you how important it is to have someone help you navigate, um, especially during the enrollment period, to make sure you get the plan that you need.
• 30:09
  SPEAKER_03: Plans do change every year.
• 30:11
  SPEAKER_03: It is a very dynamic market, and uh, you need to be aware of those changes, especially as expensive as healthcare is.
• 30:18
  SPEAKER_03: So make sure and check out the link to Colorado Health in the show notes.
• 30:22
  SPEAKER_03: In our next episode, if you're feeling foggy and tired and wondering when your get up and go got up and left, I am bringing on Darla McCann on the show.
• 30:33
  SPEAKER_03: She's gonna talk about how women, 60 plus or men, can reclaim their energy and mental clarity and stay proactive in health.
• 30:42
  SPEAKER_03: After all, who wants another doctor's visit or refill of a prescription drug if there are things that you can do yourself to live your best life?
• 30:49
  SPEAKER_03: Darla is a dynamic and heartfelt speaker, writer, and podcast host who brings practical science and deep compassion to every conversation.
• 30:58
  SPEAKER_03: Make sure you follow us so you don't miss an episode and join us on how you can get back your get up and go.
• 31:05
  SPEAKER_03: Until next time, get savvy.