How Are Baseball Umpires And Insurance Brokers Similar?

UmpireI understand, “I calls ’em as I sees ’em.”

When I was a much younger man I did some umpiring for my son’s Little League baseball association.  As an umpire, I learned that I could not make everybody happy.  As long as I focused on the action taking place on the baseball diamond and ignored the parents in the stands, I was alright.  When I tried to please the spectators, I always got in trouble.

Here in 2013 I can still draw on the lessons that I learned years ago on the baseball diamond.  Many of my clients and readers are still upset and confused about Obamacare.  As an insurance professional, as long as I stick to the facts and avoid political gamesmanship, I am okay.

Unfortunately, that is easier said than done.  The current president and congress have turned health insurance into a confusing mish-mash of political garbage.  New federal regulations must mix with existing state laws.  It is often not easy to separate political rumors from facts.

Last week I was visiting with a colleague who practices a different form of insurance from what I do.  He asked me what the future has in store for health insurance agents once Obamacare’s Essential Benefit Plans and Health Insurance Exchanges start in 2014.

Use the form to ask your insurance question.
Use the form to ask your insurance question.

I told him that the agent who was nothing more than a health insurance sales-person would shrivel up and die.  There are too many changes happening for someone who is not capable of learning new things to survive.

However, as I see it, the insurance professional who is flexible and able to learn new things has a bright future.  The types of insurance we will work with have not even been developed yet.


The most well-known of the new plans are known as the Essential Benefit Plans (EBP).  The benefits that are in the EBP were finalized by the Secretary of Health and Human Services.  As per section 5000A of the PPACA, every American will be required to buy one of 5 versions of the EBP by January, 2014.

Those who get their health insurance through their employer, do not have much to worry about.  Their employer, working with their insurance company, should make certain that their plan is compliant with the new regulations.

Those who do not get their health insurance through their employer will have to change their health insurance plans unless they are exempt from the “Individual Mandate.”

You should be able to make your change as early as October through either your insurance broker or one of the new Health Benefit Exchanges.

There are rumors circulating that people who have current health insurance may be exempted from Obamacare’s Individual Mandate for a few months in 2014.  There is a proposal to allow them to wait until the anniversary date of their policy before they are required to switch to an EBP.  I will notify people through my weekly email once I get confirmation.


One of the arguments that the politicians in the 111st congress used to justify a federal take-over of the health insurance industry was that people were having to file bankruptcy even though they had health insurance.

I find it strange that a congress that used that as a justification has stipulated that all Americans must buy one of 5 different health insurance policies that do not prevent the problem we were promised would be solved.

Not one of the EBP options provides first dollar coverage.  All of the plans will still have deductibles and co-insurance.  The chance of filing for bankruptcy because of medical bills, even though you have qualifying health insurance still exists.  Obamacare did not solve that problem.

As I see it, the insurance industry will be developing low-cost supplements to pay for medical bills that the EBPs do not.  Already some supplements already exist.

Last week I learned about a new plan that has been presented to the Texas Department of Insurance for approval in my state.  It combines Critical Illness with Accident Supplement insurance.

As I see it, this new plan is only the first of several supplemental plans that will be made available to Americans only through their insurance professionals.


When the politicians were making their emotional arguments, they only told one side of the story.  In many cases, the reason why people had to “file for bankruptcy protection for medical bills even though they had health insurance” was because they relied exclusively on the government to take care of them.

The doctors and hospitals got paid most of their money from the insurance company.  The bills that did not get paid were the mortgages, credit cards and car payments.

That is because Major Medical insurance only pays medical providers while you are sick.  It does not give you money, on which to live, while you are recovering from an accident or illness.  Neither does it pay for your retraining if you are not going to be able to return to your previous job.

Many people believe that Social Security Disability insurance will protect them if the worst happens.  However there are some facts about Social Security Disability insurance that many people do not realize.

  • SSDI has a very strict definition of “disability” that you have to meet.
  • SSDI has a list of conditions.  If your disability is caused by one of the automatic qualifiers, your benefits will start 6 months after you become disabled.
  • If your disability is not caused by one of the automatic qualifying conditions, your benefits will not start until after SSDI has approved your claim.  That approval can take months or years.  However, once you are approved, your benefits will be retroactive to a point in time 6 months after you became disabled.

Until your SSDI checks begin you must find another source of money.

Ideally, you have sufficient savings on which you can rely until SSDI approves your claim.  Most money managers recommend that you have 3-6 months worth of “Rainey Day” savings just for this purpose.

Unfortunately, I have learned that many Americans do not have a 6 month “Rainey Day” fund.  For them a private Short Term Disability Income policy acts as a necessary supplement.

The Short Term Disability Income policy can provide money that you can use to pay the mortgage, credit cards and car payment while you are waiting for your SSDI checks to start.

As I see it, as 2014 arrives, insurance professionals are going to have to take time to closely look at the Essential Health Benefit plans.  The Navigators that will be contracted with the federal government may be able to help people see what the new health insurance plans cover.  It will be up to health insurance professionals to help people see what they do not cover.

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