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On the Third Hand: Medicare trap

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The people who love the Patient Protection and Affordable Care Act (PPACA) in a completely accepting way can cope with even the most bizarre problems by choosing to see what they want to see.

Does a PPACA public exchange qualified health plan (QHP) have just one hospital with a clean floor in its provider network?

Well, find an anecdote about a 63-year-old woman with gout who lives in a yurt under a highway overpass in Des Moines, Iowa, with her goats and now has coverage for the first time and look at that, not at that pesky provider directory. (Which, truth be told, probably doesn’t come up on properly, anyway.)

Some of the people who hate every punctuation mark in PPACA simply because President Obama signed the law can cope with the truly, catastrophically, immediately dumb stuff by getting out the champagne, or, if they don’t drink, the fizzy lemonade.

Agents, brokers, consultants and plan administrators occupy a middle ground: Whatever you, personally, think about PPACA, to be effective, you have to do your best to understand the law, its quirks, the programs it’s created, and the entities it’s created from every possible perspective.

Maybe you agree in your heart that the drafters of PPACA are the Spawn of Satan, but, in that case, you still have to try to get into the heads of the Spawn of Satan and see what they were trying to do, and why they feel so miserably misunderstood. Even the Spawn of Satan have feelings.

A case in point (with many details changed, to try to ward off the Hounds of HIPAA): A Florida broker wrote in to point out that PPACA-compliant plans give small employers no credit for enrollees over age 64 who have Medicare as the primary payer.

One podiatry practice client has a group plan that covers a husband, a wife and four employees.

The employee-plus-spouse renewal rate for the old plan — written by underwriters who understood that Medicare would be paying many of the bills for the podiatrist and his wife — was about $690 per month.

Because the feds say nothing about what PPACA-compliant plans should do when an actively working enrollee has Medicare as the primary payer, the price for a new, PPACA-compliant plan for the podiatrist and his wife would be $2,200 per month.

On the one hand, maybe that’s actually a fairly minor glitch, by PPACA implementation standards. 

On the other hand: A 320 percent increase in the cost of coverage based purely on a lack of legislative and regulatory attention is a pretty big minor glitch.

On the third hand, given how poorly the parties work together in Congress these days, maybe benefits advisors should just be grateful that some PPACA glitch doesn’t accidentally call for the military to blanket the country with Walking Dead zombie virus. Who knows whether Congress would ever manage to get a Walking Dead zombie virus fix bill past a Senate filibuster.

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