By Kirk Lyman-Barner, President

Client First Insurance Solutions

Americus and Albany

On the 10th Anniversary of the Marketplace, I am a bit nostalgic for the days when we had little
competition from agents in the individual health insurance market. Without going into the
politics of why that was, competition is very strong for agents offering
Marketplace/Obamacare plans. Unfortunately, much of that competition is a scam that
harms people.

There are dishonest agents from outside of our community who are using websites and call
centers to trick people into changing their health plans. They prey on both seniors on
Medicare and the under 65 Marketplace insured. So far, CMS/Medicare, the Insurance
Commissioners and local law enforcement agencies have been ineffective at stopping these
scams.

Recently, I had a client call me from the Emergency Room at Phoebe Sumter Hospital who was
sick and sick to find out that he was a victim of the scam. He accepted a call from someone
claiming to be from the Marketplace who suggested he should be moved from his Silver plan
that we sold him to a $0 premium Bronze plan. He is now stuck with the full hospital bill
because he was given an $8,000 deductible.

Under the current Marketplace software, all a dishonest agent needs to steal your account is
your name, state and your birthday.

In response to this epidemic of crime, the Marketplace is now going to require the insured to
complete a consent agreement. So be prepared to have this extra step this year. It remains to
be seen if law enforcement and the insurance regulators will be able to use these consent
forms to stop the bad agents. It feels a little bit like the time one guy threatened to blow up a
plane with a bomb in his shoe, and the response was that now everyone has to take their shoes
off before we can get on a plane.

You can be your own best defense against being a victim of this insurance scam by working
directly with a local agent who keeps up on all the offerings and products available in your
community. The insurance companies, the Marketplace and Medicare will never call you
about switching plans. Beware of calls offering gift card incentives. Never give out your
personal information, such as your birthday or social security unless you know for certain who
you are working with.

Other interesting notes for 2024:

For seniors, Open Enrollment is from October 15th-December 7th.

For individuals and families, Open Enrollment is November 1st-January 15th, with the last day
to enroll for a plan with a January 1 effective date being December 15th.

Like all other states, Georgia is reviewing 2.8 million people insured through Medicaid to make
sure they still qualify. There was a slowdown in the annual reviews during Covid and many
Georigians are going to lose their coverage. For those that do, they will receive a Special
Enrollment outside of the annual Open Enrollment. Talk to an insurance agent or call the
Marketplace if you find yourself in that situation.
Georgia attempted to launch a new state-run website to replace Healthcare.gov, but that was
delayed by the Federal Government until next year.

Georgia also opened up their expanded Medicaid on July 1st. Studies indicate that about
400,000 Georgians are eligible to apply. The requirements are so strict that estimates are that
only 50,000 to 90,000 will be eligible. Only 265 people were actually enrolled during the first
month.

Last year we saw a decline in customer service with the carriers offering insurance through the
Marketplace. This was in part due to an increase in customers. The Friday company was
placed into receivership and that book of business was transferred to other carriers who were
caught without enough staff to handle the new customers.

Locally, it is important to know that Ambetter clients can use the following pharmacies:
Walgreens, Walmart, Food Lion, The Clinic, The Plains Drug Store and Doctors Pharmacy.

Since CVS bought Aetna, they dropped their contract with Ambetter but they do accept the
Aetna Marketplace plans now that they have returned to Southwest Georgia.

Now that the pandemic is over, the government is no longer offering free Covid shots. Those
that have insurance will still receive $0 copay for Covid and Covid booster shots. Also the
Health Department has free shots. Those without insurance can expect to pay $120-$130 and
more for the shots.

I’d like to close with a personal appeal to sign up and take advantage of your free annual
physical, and wellness screenings. In August, I lost my father to cancer. It began as prostate
cancer and it spread undetected. As Count Rugan famously said in the movie The Princes
Bride, “If you haven’t got your health, then you haven’t got anything.” I miss my Dad. Much of
your health is in your control. Get covered and use your plan’s benefits.