Is Your Health Insurance at Risk?

Hello and welcome back to the Ask Dr. V show brought to you by Channel of Health, where you can be informed and empowered about health issues that are important to you. I'm the host, Dr. Valda Crowder, but you can call me Dr. V. I've been a board certified emergency medicine physician now for 30 years, and I have treated patients during four pandemics, one mass shooting, and a category four hurricane. So rest assured, you are in good hands today. Today we have a really, really big topic because of the government shutdown. Um, and we also have a guest. So today's topic is got insurance, what to know and do when your health insurance is at risk. My guest today is Julie Mitchell. She is uh the owner and CEO of Curated Insurance, and she will join us later to help you better understand what are your insurance options during the government shutdown, during open enrollment, and beyond. What is actually going to happen with our health insurance premiums as a result of this government shutdown, um, whether or not it occurs, uh, whether whether or not the Democrats get their way or the Republicans get their way, like what is actually happening next and what do we need to do? So, first, let's look at what's actually at stake and and what's going on with health insurance during this government shutdown and before. I want to actually try to really sort of set the table here so we can kind of understand, you know, what is the argument actually about and how does it actually impact us? So in 2016, President Obama and the Democrats passed Obamacare, which is also the Affordable Care Act. And basically, this is a series of government subsidies to make health insurance more affordable for everyone. So, since the implementation of Obamacare, 30 million people have become insured with health insurance who previously were uninsured. Now, I always remind people that whether or not someone's insured or not insured, they're still getting sick and they're still going to the emergency department, and they're still sometimes uninsured people actually have to use the emergency department and very expensive health care more often. So, since the passage of Obamacare, Obamacare was passed with um 100 percent Democratic support and no Republican votes on the Senate floor or on the House floor. So since that, since that time, uh the Republican Party has tried several times, 70 times to be exact, to repeal and replace Obamacare. So that hasn't been successful 70 times. So now the goal is, or now what they're actually fighting over is that part of the big beautiful bill was to defund Obamacare and dismantle it by actually defunding it. So how would they actually do that? So let me actually talk about how this actually works. So Medicaid, which is set up for people that are right near the poverty level, used to be uh that you qualified for Medicaid if you um were 100 percent or less of the federal poverty level as far as how much you made. The federal poverty level for 2025 is$15,000 a year for an individual, it's$60,000 a year for a family of four. So one of the things that Obamacare did was you could qualify for Medicaid if you make up to$138 percent of the Federal poverty level. So what does that look like? So if you're an individual, you make$20,000 or less, or if you're a family of four, you make$82,000 or less, then you can actually qualify for Medicaid and your health insurance cost nothing. So part of the Big Beautiful bill is to actually put in a work requirement on Medicaid that has been used in other states, other southern states, and has kicked about 30 percent of the people off of Medicaid. Then the second part of Obamacare is the subsidies in the marketplace. So if you make 138 to 400 percent of the federal poverty level, so that's$60,000 if you're an individual, or$126,000 or less for a family of four, you could go to the marketplace and you would get a federal subsidy. So here's how the federal subsidy would work. Let's say normally the insurance would be$1,000 a month. You qualify for a$700 a month subsidy. So the federal government pays that$700 to the insurance company, and what you pay is just the$300. So part of what they're fighting over now is to they want to phase out or eliminate that subsidy. So that if you're making$100,000 a year, you might have to pay$1,000 or$1,500 a month for health insurance. That is going to price many people out of the marketplace. So it is estimated that roughly about 20 million people will lose health insurance if these changes go forward. And this is the fight that they're actually having now, which has actually led to the shutdown of the Federal Government. Now, if we keep on going, there's people like myself where I get my insurance through my employer, and there's people who actually make more than 400 percent of the Federal of the Federal poverty level. We all would be impacted as well. Because as soon as you have more people that are uninsured, it drives up the cost of health care for everyone. So our premiums are also being impacted. So I really wanted to talk with uh someone uh today that actually really um is on the front lines of this uh insurance uh debate, and that is uh Julie Mitchell. I'll bring her in right after news you can use. If you want to learn more or you've got some questions, maybe you got a letter from your insurance company. All right, what the health is happening, that is the real question, and it is the name of my new podcast where you can literally get life-changing advice. Every Thursday we upload new episodes to what the health is happening, and you get the inside scoop on all types of health matters so that you can be informed and empowered about your health. What the health is happening is your dose of medical reality with me and my friends that I interview that are from the front lines of health care. Download, subscribe, and comment. Tell us what you actually uh what you need and what you want to talk about. So, here to help us unpack what is happening with health insurance, open enrollment, and the government shutdown is our guest today, Julie Mitchell, owner and CEO of Curated Insurance. Uh, Julie actually services clients across the United States and the District of Columbia. Julie, uh, thanks for joining me today. Um with everything. How are you doing? How are you? I'm doing great. I'm doing very good. I'm doing very good. Um, with everything that's going on today, uh with the government shutdown and and health insurance, your phone should be ringing off the hook. Is that what is that is that is that what's happening? It is for certain. Yes, indeed. So so tell me, Julie, what are people actually, you know, what are people calling and what are people actually concerned about?

Thank you for asking. Let me start off by saying, Dr. B, the information you bring to people, it's life-changing. So and I love that you are improving people's lives, and I thank you for supporting a healthy and productive society. That is part of my core mission. So I definitely love that I'm on the show with you and all the work that you've done.

Thank you. Yeah, you're welcome. So so what are so what are people calling you about?

People are calling me about their doctors. They're right now, doctors are a challenge. People do want to keep their doctors. They're also calling me about their changes that are getting seen in their notices from insurance companies. So those of you who have insurance, whether it's Medicare or it's um an under 65 plan, you're you've noticed some changes in in all different aspects of your plan, where the premiums are going up, likely your copays are going up, your maximum out of pocket, your deductible. So all of those things um are going up, and and at the bottom line, there's a lot of anxiety. Right. Um, what I want everybody to know is that there are choices, right? So I have um avoid 15.com. Okay. You can go there. It'll have a summary of some things you can do so that you can avoid the high cost, um, and you can make sure you've got the right adjustments that you need to make.

Right, right. So now tell me w so the insurance companies, are they sending out letters? Who's getting these letters? Because one of my girlfriends called me and said that she got a letter. I haven't gotten a letter. I get my insurance through my employer. Who is getting these letters and and what are these letters saying?

So it would be um individual, people get individual insurance. Um, an entrepreneur, um, somebody for whatever reasons isn't um doesn't have employer insurance. Um, and for Medicare, it's your annual notice of change, right? You're getting those letters uh this month so that you can compare what you have, which you normally have, to what will happen for you in 206, 2026.

Okay, and and are would you say that the folks that are calling you, like, is everyone getting letters that there's an increase? Like, is it do you feel like everyone's getting an increase? Everyone will get an increase.

And and the reasons behind that are um in four buckets the insurance companies adjustments, um, as you've mentioned, the Biden um uh extension going falling off, and with the big beautiful bill, the changes there with Medicaid, as well as the centers for Medicare and Medicaid have made some changes as well. So one of the things people are gonna see is um if you're used to a zero-dollar plan, that's no longer gonna exist. Um, plans will be at least five dollars, so your your premiums will go up at least five dollars. However, the high end is one thousand five hundred each month. Um, yeah, the premiums will rise for some people as high as one thousand five hundred dollars each month.

Okay, okay.

Now what's that's why I that's why I want to make sure people go to avoid15.com to see where they fall. Right. And it kind of helps get some um clarity on the situation.

Now, do you find is there any real difference by state or by county or or or does it not really matter? It doesn't really matter where you live.

It doesn't matter where you live as far as like whether or not your uh premiums will rise, uh, the amount you rise does depend on the state. Some states will kick in a little extra subsidy to help cover the spread. Um so those states will won't see as high of an increase. Um it's gonna I mean you're you're everybody so here's the thing, everybody's different.

Right.

Um whether you're um looking whether you're um looking to uh have individual insurance because you've lost your job, or you have individual insurance because you're an entrepreneur, or you're the spouse of someone and the um compensation at work isn't enough, right? That is gonna go ahead and cover you.

Okay.

One thing though that is still intact with the Affordable Care Act is that your premiums need to be 10% or less of your income, right?

Okay.

So for the people that are between 138 and 400% above the federal poverty level, you're still going to have a tax credit that will help you afford your tax bill, afford your, I'm sorry, your monthly premium. Um where the cliff comes in, that you're you've got two things. Your your insurance has risen and you're not going to be covered by the subsidy. So that's why that extra, and it's an extra$1,500. So let's say you're you're used to paying, you know, a thousand dollars a month for your um bill for your family.

Right.

And then it'll rise an extra$1,500, so you'll get$2,500 a month.

Wow. So so let me ask you, let me ask you this. When you said that the tax credit will remain, uh so basically I still have to put out the additional cash for 12 months, and then I I don't get the rebate or the the tax credit till the end of the year, correct?

Um, so the the beauty of the abortive affordable care act is that it's an advanced tax credit. Okay. So a subsidy is what what the subsidy is, it's an advanced tax credit. So instead of waiting until tax time to get the money reimbursed, it gives it to you real time. So each month they apply a tax credit. Another piece of the big beautiful bill that people need to make sure that they're thinking of this this season is you've got to reconcile your taxes. That's going to matter more than it has in the past. Because if you haven't filed taxes and you haven't reconciled, then that subsidy will not be there for you, right? Um, which means you've filed your taxes, you did your your forms, so that if the tax credit was too high or too low, you've paid the difference.

Okay. Okay, so let me ask you this. So um Medicare, which uh, you know, really impacts those that are 65 and older, you know, a lot of uh elderly people are looking at um, you know, Medicare Advantage. Um can you kind of explain a little bit about what is Medicare Advantage and how how would Medicare Advantage be impacted by this?

Certainly um let me bring it up a little bit um higher. So Medicare, just to be uh, because Medicare and Medicaid often get confused, Medicare is for people that are 65 and older, and it's also for people that have a disability like end-stage renal um disease. So it can this is Medicare can be for all ages. It's mostly for people that are 65 and older. And if they are coupled with having Medicaid because they're low income, then that's the the population that's mostly impacted because generally they don't have what they need to meet the work requirements.

Right.

So they're looking at how do we do some form of supplement. There is the Medicare Advantage Plan, which takes over your Medicare, and it can be the best bet for somebody because you don't have underwriting and the premiums are pretty low. Now they do have other parts with it. So um sometimes the better bet is to do the the Medicare supplement, um, one of those plans, but you do have to go to uh through underwriting, and they do have a higher monthly premium. Okay. So the big thing for people to know on on the show right now is to go to avoid15.com because we you're put in your situation and we can see where do you fall? So take good care of yourself and take good care of your health care, you know.

Right, right. So so I I'm just kind of I'm curious. I mean, do you think that any of this will you know, we're we're in this government shutdown now because they're arguing about this, right? So Right, rightfully so. Yeah. And uh d do you think that like if if we're able to actually get these subsidies back, will the premiums go lower? Like what what's gonna actually I it seems to me like, and this is just how I'm looking at it, it seems to me like the insurance companies are assuming the worst. Is that is that what's happening? Because I I'm people are getting letters with like almost, you know, you know, 50, 100 percent increase in their health care premiums, which is why I decided to do this show today. So, you know, are are are health are health insurance companies assuming the worst and that they're assuming that the big beautiful bill is gonna go into effect and all of this stuff is gonna happen. Are is that what's happening?

Or do we have the assumption is the assumption is that um the big beautiful bill will go into effect, that the subsidies will not be um extended. And the biggest reason why we we have to we have to assume that, right? Okay, in order to prepare for 2026. And in talking about these different things, at the core of what I'm experiencing with people is high anxiety, right?

Yes.

What is more important now than ever is that you find a good agent because what we do is we bring a strategy around that fear and anxiety that you may be feeling.

Right.

What we'll find out is, you know, what is your situation? Where are you? And how can we tailor a plan that fits your needs, more importantly, your budget, right? Right. Um and that's that's why I did the uh the website for for the show, avoid15.com.

Right, right. And what is 15 with what is 15 is standing for what?

The 1.5k, I'm sorry, avoid 15k.com. Okay. Um it is it's avoiding that one 1,500 increase that is possible.

That is possible. I gotcha. Okay. So so now uh what what about what about Obamacare? Are you seeing that that is still a good option? Because I'm I'm seeing even for Obamacare, premiums are are a thousand dollars or so. Um, does it does it matter if you're married or have a family? Like what what sort of things actually make a difference?

Obamacare is a brilliant, it's it's brilliant. I mean, it came from the Heritage Foundation, um, and Obama adopted it, and the core of what it was resolving is as you said earlier in the st show, we as taxpayers pay for emergency room visits by those people who don't have the money to take care of themselves in other ways. Right. And what was figured out is it's less expensive for taxpayers to subsidize a plan that gives you preventative care, right? Right. It gives you doctor visits so we can reduce the the cost of an emergency room.

Right, right.

Right.

And and a lot of people don't realize that um we are federally mandated through uh Mtala in uh in the emergency department to actually take care of and deal with all emergency department all emergency complaints, um, no matter whether or not you have insurance or not, right? So so the emergency department, uh which is you know where I work, is is really the safety net of the healthcare system. Um and when people are insured and they cannot get in to see their doctor, and sometimes it's people who even are insured and still can't get in to see their doctors, because trying to get an appointment to see your doctor sometimes can be kind of difficult. Do you know what I mean? I mean, I got a letter just I got a letter just two weeks ago that my doctor had quit. I said, Oh my gosh, I gotta find a I gotta find a new doctor.

So And same here, same here, and that's devastating when you find out your doctor's taking a break or quit. Yeah, like what what what am I what am I supposed to do? I'm like, I have medication I need to get to.

Yeah, I've got to go back to the catalog and figure out who I like and then try to see if they're accepting new patients and then make an appointment. And here's the thing is I always tell people, and I'm healthy and well, right? What if I was doing this and I I'm not uh I'm not healthy and well. So, Julie, why I have you, I want to actually talk a little bit about Medicaid. Because one of the things that I actually didn't realize was 41% of the children born in America are born and their deliveries are paid for by Medicaid. So, so you know, tell me what's actually, you know, we may have listeners who might be might be pregnant or um in the middle of a pregnancy. Um, how does, you know, how how does Medicaid work and provide insurance for those that are are pregnant?

So Medicaid, it depends on your state. So some states um are better about Medicaid, some states are not so good about Medicaid. When it comes to pregnancies, I it's a universal desire in our society to make sure that pregnant um pregnant women and children are taken care of. So in that realm for Medicaid, you're gonna be okay.

Okay.

For the most part, there they're listen listeners who who may feel some anxiety over this, take a deep breath. We've got we've got you taken care of. There is a plan that we can do, we can help you, whatever your situation. Is um you you you're gonna need an agent more this time than ever and get that clarity so that you can do it, put a strategy behind that fear.

So and then lastly, you know, here in Washington, D.C., we have a lot of people who have separated from their jobs, um, particularly government employees. Um, and some of them are actually um having to use COBRA for their insurance. Um so are you know, are we seeing the same increases in COBRA rates? Or if you separated from your job and you were given a COBRA rate for a year or two years, I don't know exactly how it works, do they have to honor that? Um, you know, given that we have so many people separating from their job, what is what is do you know what's happening in that in in that area of the marketplace?

Yes, with Cobra, you're going to have um, gosh, Cobra is the same benefit that you had through your work and your employer is no longer chipping in. So the big surprise there, without any increases in the insurance, is that you're now not getting that employer contribution, and I've saved people$300 to$800 monthly just from Cobra to a different type of plan, right? So those aren't necessarily going to increase as much. It'll be the same as what your employer insurance was before. It's just you don't have the employer contribution.

Okay.

And for those people who are leaving or or losing, somehow changing their emplo employment, um, you know, reach out to an agent, and there's some really great resources for not only the Affordable Care Act, but also alternative plans, because there's some alternative plans, and you have to be careful, because some of the plans are not good plans, and some of the plans have don't have great publicity, right? They're good plans for someone, but they're just not good plans for everyone.

Right, okay.

And having a a professional help you navigate this landscape, because my goodness, I I am educated, I promise you. It took me a good six months before I could wrap my head around what the insurance companies were doing and why they were doing it. And this was before all the changes with the government, right?

Right, exactly.

Yes, exactly.

So, so Julie, are there any things that you think people should be asking or should be trying to figure out during this time period?

Start with your doctors. Find out what networks your doctors are going to be in. Um, your income and your budget. This this time your income is gonna matter more than more than anything to the penny. No, give the best projection you can, right? Um and and seek a professional on this. Um I can't say it enough because the people that I uh help at the end of like trying to figure things out, they're frazzled, blah, blah, blah. And they're like, made that so easy. I made it easy because I do it a lot, but I can't imagine being on the other side and just coming into it without professional help. Um, so yeah, avoid it's avoid 15k.com and um make sure that you're not one of those that has that up to 1,500 increase.

So, Julie, if any of the listeners have more questions or they want to get in contact with you, you do you do provide um insurance brokerage help in all in all 50 states? Correct.

Correct.

All right, and how would they states in DC? All right, wonderful. And how would they get in contact with you or email either an email or a phone number?

Yeah, my phone number is 214-831-7037.

All right, I want to thank you. That's my last question for today. I love answering your questions and empowering you and your family with health information because it can improve your overall health. Be sure to send your keep sending your questions in. You can email me at infotasv.us and that's info at askvr.us.