Episode 2136 notes

The ACA/Obamacare Mega Tsunami is coming! Increases premiums, Reductions in subsidies and the impact this will have across the country, and it's here as we begin 2026.

My expert guests from Detego Health are John Stockton and Tracy Krause, who will discuss GigCare, provided by Population Science Management as the alternative to the ACA (Obamacare): Better benefits and lower costs.

Stockton tells us "If you become a consumer data respondent, you can have access to PSM’s GigCare Health Benefits plan".

Today we will separate fact from fiction on the topic of health benefits on America's Healthcare Advocate.

This is episode 2136

GigCare is not available in all states. Learn more at https://gigcare.net/

And if you need help or have something to share, contact me Cary Hall, America's Healthcare Advocate at https://www.americashealthcareadvocate.com/contact-us

And let me know what's on your mind, issues you are dealing with, or other health, healthcare, and health insurance questions and concerns.

00;00;06;11 - 00;00;29;20

Cary Hall

Hi, I'm Cary Hall, America's Healthcare Advocate. On our show today, we're going to talk about the mega tsunami that's coming. That's right. The mega tsunami that's coming with all of the ACA Obamacare plans. We're going to talk about an alternative. You're a 1099 employee if you're self-employed out there, if you're a realtor, if you're a contractor doc, if you're an Uber driver, whatever the case may be, we've got something it is worth taking a look at.

00;00;29;26 - 00;00;34;28

Cary Hall

It's called GigCare. Stay tuned. You're going to learn a lot on this show today.

00;00;35;01 - 00;00;39;12

Announcer

And now America's Healthcare Advocate, Terry Hall.

00;00;39;15 - 00;00;54;08

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across USA here on the HIA Radio Network. My producers in studio today, Mr. Dave Thiessen, the man behind the cameras that posts all these shows up on our podcast YouTube platform.

00;00;54;10 - 00;01;15;24

Cary Hall

By the way, 604,000 of you have viewed our YouTube and podcast. We're pretty happy about that. We want to thank you, all of you out there in the audience that pay attention to this show and go up to our YouTube platform and our 16 podcast platforms. By the way, our website is AmericasHealthcareAdvocate.com. If you have a question or comment, please feel free to send me an email.

00;01;15;26 - 00;01;33;08

Cary Hall

I get a lot of them, but I answer each and every one of them. So if I can help you, I am more than happy to do that. If you are chronologically challenged and you're looking for Medicare coverage, or you're struggling with this Obamacare issue that's coming on board right now, you can always reach out to the lovely Carolee Steele over at RPS Benefits by Design.

00;01;33;10 - 00;01;59;02

Cary Hall

Wherever you are in the country, they're happy to help you, with Medicare or with ACA. Additionally, if you are an employer looking for an opportunity that might be something different you probably ought to call Maria Ahlers over at RPS Benefits by Design 877-385- 2224. Anywhere in the country 877-385-2224. In studio with me today, John Stockton and Tracy Krause from Detego.

00;01;59;09 - 00;02;16;15

Cary Hall

We are going to be doing a show today on GigCare. So this show today and I've wanted to do this for some time. We're going to talk about why GigCare was created. Detego is the parent company that created GigCare. Why did we create it? What does the product do? And it's a health benefits plan.

00;02;16;20 - 00;02;33;24

Cary Hall

And who is this product really For. So that's what we're going to talk about today. And here's here's the thing you want to keep in mind. There's a huge tsunami coming in ACA right now, with all the increases and the reductions in subsidies and all the rest of it, it's going to impact people across the country in a lot of different ways.

00;02;33;29 - 00;03;00;25

Cary Hall

In addition to that, okay, if you're a 1099 employee out there, if you're if you're an Uber driver, if you're a contract ER doc, if you're a contract ER nurse, if you're a contract anesthesiologist, if you're a realtor, if you're a truck driver and you're 1099, this might be a health benefit plan you want to take a look at. But we're going to start off by just talking about what's going on in the marketplace today and the disruption that we expect to see.

00;03;00;25 - 00;03;15;23

Cary Hall

So, John, let's talk about that a little bit there. You've got a table there that's talking about some of the increases we're going to see across the country. Let's talk about that and the disruption that we're going to see. You. And I kind of nicknamed it the ACA tsunami. So let's talk about that.

00;03;15;28 - 00;03;24;01

John Stockton

I think the only place I would disagree, Cary, I went into ChatGPT and I said, what's bigger than a tsunami? And the answer is a mega tsunami.

00;03;24;03 - 00;03;27;06

Cary Hall

Okay. I didn't even know that existed. Okay. So I'm impressed.

00;03;27;06 - 00;03;53;17

John Stockton

The the average increase for the ACA across the country is 23.43% projected at this point. There are a handful of states that I circled that just are eye popping. Texas is at 31, Tennessee's at 35, North Carolina is at 28. New Mexico's at 36. You see these Arkansas is at 36. Delaware is at 38. You just see the impact of the ACA.

00;03;53;17 - 00;04;02;26

John Stockton

You seen a large carrier pull out of the ACA. So the in and that impact is just the base rate increases, not even considering what's going on with the subsidies.

00;04;02;28 - 00;04;15;10

Cary Hall

Yeah. So when you put all that together, if you're not on an employer sponsored health plan and you're out there on your own trying to figure this out, it becomes much more challenging and much more difficult, does it not?

00;04;15;11 - 00;04;35;02

John Stockton

Oh, it absolutely does. You are stuck and you are relying upon the ACA to take care of your needs. And we know that with this magnitude of increase, the people that will leave the ACA are those that can leave the ACA. So in our opinion, the ACA is looking at a death spiral and it's only going to get worse.

00;04;35;04 - 00;04;58;25

Cary Hall

And the reason we say that is because the only people are going to stay on there are the people that have to stay on because they're too sick to get off. And we're already seeing that in the marketplace with a lot of people. I would say if you look at people below the age of 30, 35, even below the age of 35, and you ask them, do you know, it was funny, we were on a on a zoom meeting here a couple about a month or so ago, and there were a number of very young people on there who were IT people.

00;04;58;25 - 00;05;06;03

Cary Hall

And we asked how many of them had health insurance. They laughed. They said, Tracy. They said, no, we don't need health insurance.

00;05;06;06 - 00;05;07;03

John Stockton

I'm like.

00;05;07;05 - 00;05;21;15

Cary Hall

Okay, you don't need health insurance. And with that's the attitude. And the other part of the attitude is that Obamacare, ACA is too damned expensive and they just don't feel like it's worth what they're going to be forced to pay for it.

00;05;21;17 - 00;05;28;25

John Stockton

The underlying cost of health care is a whole separate conversation you and I have had before, Cary, but the financing model for the ACA is not working either.

00;05;29;02 - 00;05;50;05

Cary Hall

No. And we only think it's going to get worse. So let's talk a little bit about let's just talk about why this product, Detego is the parent company here, Population Science Management is the company that actually offers the GigCare product. We can talk about that a little later, but the GigCare product was actually designed to go into the 1099 marketplace.

00;05;50;05 - 00;05;58;26

Cary Hall

People that are 1099 folks out there that don't have group health insurance plans now, they're how many of them are there? 80 million now, John.

00;05;58;28 - 00;06;06;07

John Stockton

80 million. By the start of 2027, the gig economy will represent 100 million Americans which is astounding.

00;06;06;07 - 00;06;22;08

Cary Hall

So we think that this is an opportunity for people in those areas, people that are realtors, people are those Uber drivers, people that are contract drivers for Fedex or those Amazon drivers that are contract Amazon drivers or the truck drivers or such a broad.

00;06;22;08 - 00;06;27;28

John Stockton

It's hospitality. It's the beauty space. It's the tattoo artists, the musicians and.

00;06;28;00 - 00;06;29;19

Cary Hall

The tattoo artist. John, that was one.

00;06;29;19 - 00;06;34;16

John Stockton

It's a very broad message. When you start talking about 80 million today, it's again very broad.

00;06;34;16 - 00;07;01;06

Cary Hall

And those are the folks that don't have access to employer sponsored health care. So they're looking for an alternative. And the GigCare product was created specifically for that marketplace to give them an opportunity to find health benefits that were better than what's on ACA, that were less expensive than was on ACA, and actually offer a wider range of coverage in some areas than what we see on ACA.

00;07;01;13 - 00;07;16;25

John Stockton

I would just also add, Cary, it might be for W-2’s that are part time and not eligible. So GigCare is a great fit for those who aren't eligible. So we talked to a lot of large employers who have a number of part time employees, where this is a consideration.

00;07;16;27 - 00;07;35;29

Cary Hall

That brings to mind some of the other employers that we've talked to. Okay. You know, we have a trucking company out of Lincoln, Nebraska that has 4000 truck drivers. Well, it turns out 400 of them are 1099 people. And they didn't have any health benefits to offer them. We're seeing this in co-ops, agricultural co-ops across the country. Right, John?

00;07;35;29 - 00;07;41;09

John Stockton

Absolutely. A lot of large farmers co-ops, a lot of association opportunities that it's created for us.

00;07;41;10 - 00;07;56;03

Cary Hall

Where they're not where they don't have access to the kind of health care we're talking about unless they go on the ACA, Obamacare, which unfortunately, a lot of them just are not don't want to do or have had a bad experience with or it's cost prohibitive now.

00;07;56;03 - 00;08;09;18

John Stockton

It is cost prohibitive. And depending on what happens with the subsidies, it could get even worse. It's still the average increase going up 23.4% is is with the subsidy staying the same. So it could it could get significantly worse.

00;08;09;21 - 00;08;23;01

Cary Hall

Yeah. And that's a state by state thing. So so you're seeing that say this is another thing we'll talk about when we start talking about the plans here. But our plan pricing is universal across the country. It doesn't change on a state by state basis like ACA does. Correct?

00;08;23;01 - 00;08;29;25

John Stockton

Correct. We have the same rates across all of our state where we offer our coverage, and they're just by age band.

00;08;29;28 - 00;08;50;06

Cary Hall

So it is by age band. We offer it across the country and we come back from break what we're going to do is we're going to start talking about GigCare, how it works, who it serves, and how you gain access to it. If you want information on this, by the way, if you're a broker and you want to learn how to sell this product, I'll take it out in your marketplace.

00;08;50;13 - 00;09;18;09

Cary Hall

We are happy to have you. It's very simple. Here's what you do. You go to GigCare.net, GigCare.net. There's information up there. Fill out a card, send it into us. Okay. On the web, it's easy to do. Okay. Or you can call 866-886-2030. That's 866-886-2030. Be happy to chat with you. And if you're somebody looking for this kind of health benefit, we're more than happy to talk to you about what we're offering at GigCare, how it can serve you, and why.

00;09;18;09 - 00;09;36;23

Cary Hall

It could very well be something that would be better for you from a cost standpoint, and also a benefit standpoint, and what's in the marketplace today or what's actually coming to the marketplace. So we'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across the USA.

00;09;36;23 - 00;09;51;14

Cary Hall

Once again, that website is GigCare.net that phone numbers 866-886-2030. Stay tuned. We'll be back with more.

00;09;51;17 - 00;10;10;25

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA here on the HIA Radio Network. If you want to find out more about us, go up to the website America's Healthcare Advocate. By the way, you hear this show. You want to tell somebody about it. Maybe you've got a company that's got 1099 employees along with W-2 employees.

00;10;11;02 - 00;10;30;08

Cary Hall

You go up on the podcast platform, it's on SoundCloud, Spotify, 16 platforms across the country, and our own YouTube channel, America's Healthcare Advocate. All you gotta do is tell them to go listen to the show there. They'll understand exactly what we're talking about. Once again, it's AmericasHealthcareAdvocate.com. The YouTube channel is America's Healthcare Advocate.

00;10;30;13 - 00;10;52;26

Cary Hall

If you want information, maybe you want to find out more about this. 866-886-2030. 866-886-2030 or GigCare.net. All right. We're going to change up a little bit. Tracy. So let's talk a little about you know, I don't know who it was I was talking to not so long ago. We were talking about customer service. He said, you know the problem.

00;10;52;28 - 00;11;13;10

Cary Hall

The word service has gone out of customer service. And so especially when it comes to health benefits and when you when you're talking to people, they've got a claims issue or a provider issue. How critical is that. And I ask you to come in today to talk about this. Because that's really your area of expertise. And one of the things that you help us do and do so well.

00;11;13;10 - 00;11;15;09

Cary Hall

So let's talk a little bit about that, Tracy.

00;11;15;11 - 00;11;43;18

Tracy Krause

Great. Thanks, Cary, for having me. I 100% agree with you. I've been in the customer service area for different consulting firms, for different carriers now in this role with Detego, and it's really putting that service back into the customer service. There aren't many things as personal to somebody as their health care. And at that point in time, when they're at the doctor's office and they have that ID card, that's their insurance, that's their security, and they need to make sure it works.

00;11;43;21 - 00;12;09;17

Tracy Krause

So at Detangle Health, we have the customer service agents who are live. We're also leveraging artificial intelligence. Right. We're doing some of those voice IVR as you know hit a button go here. But at the end of the day it's being able to talk to a live person who can listen to you, understand. And then direct you through the right ways in order to get your questions answered, your problems resolved, your doctor's office answered.

00;12;09;21 - 00;12;19;18

Tracy Krause

That's really what it's about. It's that first point resolution, and that sets the tone for that relationship between the member and the coverage that they purchased.

00;12;19;19 - 00;12;38;12

Cary Hall

And I think one of the things that separates us from the national carriers, if you will, you know, when you call and there's four voice prompts you have to go through before you get to the fifth one. And if you're lucky, if you're lucky, you might be able to actually talk to somebody. Okay. Our program doesn't work that way.

00;12;38;14 - 00;12;40;29

Cary Hall

Customer service starts. What time does it start? In the morning? Seven.

00;12;41;02 - 00;12;41;23

Tracy Krause

Seven in the morning.

00;12;41;23 - 00;12;55;19

Cary Hall

And it goes till six at night. So obviously we've expanded the hours so people have more of a chance to call if they have an issue. And the idea is, as you said, to have a live person there to talk to them so that they, they know they can get their problem resolved.

00;12;55;20 - 00;13;19;06

Tracy Krause

We've even gone to that outbound proactive reach. So once a member has had the conversation with their agent, they've selected the plan. And then things kind of go into that quiet period, right? We've started that proactive outreach where we're calling the members and saying, do you have any questions? Did you have anything? Maybe now that you've had the plan in place for a week or so, what kind of questions do you have?

00;13;19;06 - 00;13;43;22

Tracy Krause

And we've really uncovered what those, employees, what those members are trying to buy and how we can help them. It's about finding the right information. It's also about, in this day and age, right. We've got five generations in the workforce. You've now got those same five generations seeking health care. And they all have different needs. And so it's just providing them the information they need for their health care journey to be successful.

00;13;43;25 - 00;13;47;22

Tracy Krause

That's really a lot about the customer service aspect.

00;13;47;24 - 00;14;07;27

Cary Hall

You know what I always used to say it, I've been I was broke for 27 years was. It's not if you're going to call, it's when you're going to call. You will have an issue. Somewhere along the line there will be a provider issue or there'll be a claims issue or something will happen. But the idea is that we've got somebody there to help you, and we're not just telling you, well, that's your problem.

00;14;07;27 - 00;14;09;01

Cary Hall

You need to get it solved

00;14;09;01 - 00;14;10;06

Tracy Krause

100%.

00;14;10;09 - 00;14;28;29

Cary Hall

And that's the whole purpose behind customer service. Switch a little bit to now how we communicate with brokers. Because we are 100% broker distribution. That's important for you to know all right. So we rely on our brokers all over the country, to take our product out in the marketplace. And we go to a lot of trouble to service our brokers.

00;14;29;05 - 00;14;37;24

Cary Hall

And give them the information they need in the tools they need. So let's talk a little bit about that and how if a broker has a problem, what we do to step in and help them.

00;14;37;24 - 00;15;00;15

Tracy Krause

So the level of service that we provide is equal to the education that we set it up in the beginning. Right. Let's let's all be on the same page. Right. Population Science Management, which is administered by Detego, is an opportunity for your clients to get access to a group health plan. Now within Population Science Management we have different segments.

00;15;00;15 - 00;15;34;11

Tracy Krause

We have the GigCare, which is what we're talking about today, right. Major medical comprehensive coverage with three different provider networks to choose from. Great. We also have Max Guard, which is a limited benefit plan that also now has a network. We then also have reference based pricing models, which might be what the agents and brokers clients once we are here to be that one, stop with three different solutions that may or may not be the best fit for your client.

00;15;34;11 - 00;15;36;28

Tracy Krause

But we are here and we do provide a solution.

00;15;37;02 - 00;15;52;17

Cary Hall

One of the things we do is who really goes to a lot of trouble to educate the brokers, talk about that and what that because you're not just going to walk in and get this product and take it back out on the street. So when you go to sell an ACA product or when you go to sell a Medicare product, you go through a whole training process.

00;15;52;19 - 00;16;00;22

Cary Hall

You go through a training process to sell GigCare. Any of the Population Science Management plans, you have to go through it. So talk about that.

00;16;00;24 - 00;16;29;00

Tracy Krause

This is a great opportunity. This is delivering a health care model in a different space. Right. And again we're not for everybody. Population Science Management isn't that ACA where you're going to drop those unhealthy people. People are unhealthy right. It happens. Things happen. What this is is it is that absolute health benefit option for you to choose from.

00;16;29;02 - 00;16;58;27

Tracy Krause

And each one of our tiers within Population Science Management serves a different purpose for the clientele that you're going after, right? That early retiree probably is going to want a GigCare plan, right? It's got three different national networks. It's got the comprehensive coverage that, rideshare driver, they're not going to want that comprehensive coverage. They probably got that Max Guard suite of plans for them to consider.

00;16;58;29 - 00;17;17;21

Tracy Krause

What we do up front, though, is have that education for those agents that want to take the time. Right. This is the GigCare. This is Population Science Management. This isn't Medicare and this isn't ACA. And this is unique to our space. And it's an absolute solution for your clients.

00;17;17;21 - 00;17;33;29

Cary Hall

And so what that means is if you're the broker and you're listening to this and you're interested, there is a training process. You actually have to take a test, okay. And you have to go through this training process. And the reason for that is because as Tracy just said, this isn't for everybody. There are different plans that fit different needs.

00;17;33;29 - 00;17;54;22

Cary Hall

And that's what we're doing here. We're talking specifically today about GigCare. That plan, which primarily services the 1099 market. But if you want information you're interested in, you've got an area out there that you cannot get those clients coverage. You can't find policies. They like narrow networks. Under ACA, prices are too high. They don't want to do it.

00;17;54;27 - 00;18;17;00

Cary Hall

Now you've got a product that probably makes some sense, but you're going to have to go through the training and education process so that you can present it the way it needs to be presented. If you want information, go to the website GigCare.net, that's gig hairnet or call 866-886-2030. 866-886-2030. Stay tuned. We'll be right back after the break.

00;18;17;00 - 00;18;34;16

Cary Hall

We're going to get into the plan designs now. And what are they actually look like and what do they cover? We'll be right back after the break. Stay right there.

00;18;34;19 - 00;18;53;08

Cary Hall

Welcome back. You're listening to America's Healthcare Advocates Show broadcasting coast to coast across USA here on the HIA Radio Network. My producer today, Mr. Dave Thiessen. Behind all the cameras, Garner Cowdrey, the man behind the microphones. Again, all these shows are posted on our podcast platforms. There are 16 of them. Okay. As well as our YouTube platform.

00;18;53;08 - 00;19;13;29

Cary Hall

So you hear about this, you tell somebody about it, you want to share it with somebody. That's a great place to go. And instead of you trying to explain all of it, then go up there and listen to the whole show and get all the information so they understand how it works. We're talking about the plan today, the health benefits plan called GigCare offered by Population Science Management, 866-886-2030.

00;19;13;29 - 00;19;29;19

Cary Hall

If you want information you want to call, learn more about it. That's what you can do. Or you can go to the website GigCare.net. All our information is up there. All right John, let's get in the weeds a little bit okay. And talk about these plans. So there are seperate plans Tracy just talked about offering on separate networks.

00;19;29;22 - 00;19;34;29

Cary Hall

So first we have the Blue Cross and Blue Shield plan which is offered in Nebraska. And that plan is called.

00;19;35;04 - 00;19;46;08

John Stockton

We call that plan Thrive Okay. So we have an important partnership in the state of Nebraska with Blue Cross. And we are, very excited about our opportunities in that great state, working with the local Blues there.

00;19;46;10 - 00;20;00;18

Cary Hall

And we've got a lot of, a lot of opportunities coming up in the state, in Nebraska, a lot more work we're doing in the state of Nebraska with some of those farm co-ops in the state of Nebraska. Yeah. So let's let's switch gears, because we now have Aetna National Network to offer our clients.

00;20;00;25 - 00;20;27;27

John Stockton

So the Aetna plans are branded Livelihood with the Aetna plans. They are EPO which means in-network only. Obviously anything out of network that's emergency is going to be covered as in-network deductibles range from 1800 up to 8300. We have HSA options. Probably the more popular question Cary we get from brokers is where is the intersection between where GigCare is more competitive than the ACA

00;20;27;27 - 00;20;28;24

Cary Hall

on a price point,

00;20;28;24 - 00;20;29;16

John Stockton

On a price point.

00;20;29;16 - 00;20;36;28

John Stockton

So I wanted to talk about that real quick, because we sell in four age bands that are the same rates across all of our states that we sell into.

00;20;36;29 - 00;20;42;23

Cary Hall

But that separates us from ACA. Our rates don't vary based on the state. They're the same across the country.

00;20;42;23 - 00;21;09;11

John Stockton

Right. And so those age bands are 18 to 29, 30 to 44, 45 to 54 and 55 to 65. So this year, our sweet spot for GigCare has been really in, 40 to 45. Plus, in the first segment, we talked about the rate increase on the ACA being in 23 and change the impact of subsidies could literally have some members paying double what they're paying this year in 2026.

00;21;09;13 - 00;21;25;06

John Stockton

So we feel like our sweet spot will be pushed down into the lower age bands. But again, then there's same rates across all the states we sell into, and we expect to be competitive, certainly in that 30 to 44 and possibly even into that 18 to 29, I suspect, depending on the state.

00;21;25;12 - 00;21;43;13

Cary Hall

Yeah. Because what's going to happen is as the subsidy is reduced and the prices go up, our prices have pretty much stayed the same. I think our increase this year was 7% if I’m not mistaken. So, I mean, when you compare that to what's going on in the marketplace, that's pretty significant. And by the way, that's the same increase that we had last year.

00;21;43;13 - 00;22;09;16

Cary Hall

So we're very proud of the fact that we were able to keep it in the single digits and down to 7%. So again, you know, let's talk about some of the plans. So you mentioned the HSAs and some of the high deductible plans. And this goes back to you know, what Tracy was saying earlier. What the 25 year old Uber driver needs is not what the 55 year olds, you know, looking at retirement now in five years or ten years, whatever it is, they don't have any children at home.

00;22;09;16 - 00;22;15;02

Cary Hall

If they're empty nesters, an HSA at $6,500 probably makes a lot of sense.

00;22;15;02 - 00;22;30;23

John Stockton

Yeah, no it does. And I think all of our call centers do a very good job with the needs analysis. So we can illustrate both the Aetna logo or Blue Cross if we're in Nebraska. And we can also show an EPO or PPO option. So we're trying to meet the members where we are at.

00;22;30;25 - 00;22;54;14

John Stockton

Tracy mentioned Max Guard. So Max Guard literally it's a limited benefit offering with a price point roughly half of GigCare. So we had some conversations with some of our rideshare drivers, etc. it's probably represents about 30% of what we're marketing today for Max Guard. And then, for somebody who wants a more comprehensive plan, we have our GigCare solutions.

00;22;54;16 - 00;23;17;00

Cary Hall

Yeah. And so the idea here is that we've got something that fits whatever category you happen to be in if you're a senior citizen, or we're approaching senior citizen or you're 25, 35 years old, maybe you've got, you know, 2 or 3 kids in the house. We've got different plans that offer better opportunity. So let's go back to EPO versus PPO because this is going to confuse people.

00;23;17;03 - 00;23;20;28

Cary Hall

So EPO, if you're on Aetna means you can go anywhere in the Aetna network, right?

00;23;21;00 - 00;23;40;03

John Stockton

Yeah. Aetna networks are broad networks. The EPO simply means if there are out of network providers, they're not covered. You have to go in network. So our guys will work with you guys along those just to make sure the members understand the network. PPOs cost more than EPOs everything else being equal. But if you want an out of network solution BlueCross in Nebraska.

00;23;40;06 - 00;23;58;18

Cary Hall

So the idea there is that they're looking at the EPO. You've got access to the whole national network, but that's a huge network. It's some of the best hospitals in the country. MD, Anderson Sloan-Kettering go down the list okay, Mayo, they're all in there. If you're a traveling cross country, you have an accident or something happens. You need medical care.

00;23;58;20 - 00;24;11;00

Cary Hall

You're covered anyway. It's not that we're not covering you, but we're saying if you stay in the network, A, it's going to benefit you price wise, okay? And and it's an opportunity. You still got this huge network.

00;24;11;02 - 00;24;13;01

John Stockton

Cary, I was with Aetna for 25 years.

00;24;13;02 - 00;24;13;25

Cary Hall

Yes you were.

00;24;13;25 - 00;24;26;17

John Stockton

We used to run disruption analysis on all these large prospects. And if it got to more than one and a half or 2%, it was. It caught my attention. So yeah, there's hardly any out of network utilization with these large networks sometimes. That in particular.

00;24;26;19 - 00;24;49;26

Cary Hall

Yeah. Because because they offer such broad numbers here. I'm going to make a distinction here that's really kind of important. When you look at ACA those are narrow networks. You know why? I'll tell you why. Because if you control access you control cost. So what the carriers are trying to do because they are struggling to control cost under ACA, because you've got government mandated health care, here.

00;24;49;26 - 00;25;12;17

Cary Hall

And when the government mandates something, it doesn't leave a lot of leeway for these carriers to make sense out of this or even be competitive. So they squeeze the networks down. Well, the problem is, if you happen to live in Nebraska and you're in Grand Island or you're in Scott City, Kansas, you may not have a provider. You may be in a situation where you have to drive an hour, 45 minutes, whatever it is to get to a primary care.

00;25;12;17 - 00;25;34;01

Cary Hall

And if you need a hospital, you're going to go to one of the metropolitan areas for a hospital, because rural hospitals are typically not in these networks. When you contrast that with the Aetna national network, where you've got coverage across the country, there's a significant difference here. So, you know, when we talk about these plans versus the ACA plans, those are some of the things that we think separate us.

00;25;34;06 - 00;25;53;16

Cary Hall

That particular piece on networks and access. If you're in a rural community, this can be really, really important to you. And again, you know, if you do want the PPO versus the EPO, the EPO cost less money. It's a great way to save some money and still have a great plan and great access. There's coverage there for you, so that makes a difference.

00;25;53;23 - 00;26;13;20

Cary Hall

Let's switch gears just a little bit and talk about some of the differences. So Tracy, let's talk a little about the telehealth program because I think our telehealth program this is really funny. I saw an analysis the other day for the carriers are now charging for telehealth, anywhere from $25 to $65 for a telehealth visit. We don't charge for any of that.

00;26;13;23 - 00;26;16;08

Tracy Krause

Right? When you're using our telemedicine.

00;26;16;11 - 00;26;17;05

Cary Hall

MyLiveDoc

00;26;17;08 - 00;26;35;06

Tracy Krause

Correct. And but that's all about preference to. Right. You're going back to that age where they're used to what they're used to that was on the back of their card. We've partnered to provide this free telehealth, right. It's free. But this is the avenue in which you get to seek that care.

00;26;35;07 - 00;26;37;19

Cary Hall

So it's very, very different in that respect.

00;26;37;22 - 00;26;38;17

Tracy Krause

Very different.

00;26;38;17 - 00;26;55;24

Cary Hall

And there's three things we offer here. So first of all there's 24/7 urgent care emergency care. So the analysis I always like to use is, mom comes home from work at 5:30 at night. Johnny's got pinkeye. She's got to put him in the car drive him to urgent care, wait 45 minutes to an hour to see a provider get a prescription.

00;26;55;24 - 00;27;12;07

Cary Hall

Go get the prescription. Drive back home. She's just took two hours out of her day now. It's 7:30 at night. She's dead tired, and she's had to do all of this. Or, if they’re on our plan they can go to mylivedoc, pull up 24/7 a doctor, a nurse practitioner. Johnny sits down in front of the computer.

00;27;12;10 - 00;27;34;18

Cary Hall

Doctor goes, you got conjunctivitis, young man. Here's the prescription, mom. It took 15 minutes. So we think, especially in the rural communities where they have to go a long way back and forth as you just said, Tracy, this can make a big difference. The other thing that we do here is, again, we go back to rural communities. If you find a primary care provider on there that you like, maybe you live in Scott City, Kansas, you don't want to drive.

00;27;34;19 - 00;27;54;10

Cary Hall

Whatever the case may be, you can stay with that primary care doctor in a third piece. And this is really kind of important. I just did a show on this is Ryan Lefebvre, 27 year broadcaster with the Kansas City Royals about mental health and behavioral health. There is a crisis in this country of mental health and behavioral health, especially in young people.

00;27;54;13 - 00;28;14;10

Cary Hall

You know, you see all this, John? You've got two boys now that are grown and out of the house, but I've got six grandchildren, okay. They're not there yet, but they're getting there. I've got one 17 year old and there's a lot of concern about the pressure that's on them with all of these issues on behavioral health, the beauty of this program, these are free.

00;28;14;13 - 00;28;28;02

Cary Hall

There's four free business for everybody in the family. Your son, your daughter's having problems. You know, they're having problems. You can bring up that behavioral health provider. They can sit in a room with the door closed on a computer, and they can go back and forth and talk to them. How important is that private.

00;28;28;02 - 00;28;33;27

John Stockton

The generations all access care differently? I want to be face to face with the doc, my 28 and 24 year olds don’t.

00;28;34;02 - 00;28;35;02

Cary Hall

That's our generation.

00;28;35;08 - 00;28;55;03

John Stockton

They don't want to be face to face. My two boys want to be virtual, so we have to meet members where they're at. The other thing I want to mention, Cary, Tracy mentioned this earlier. The proactive outbound nature of what we do is extremely important because we're engaging the disengaged. The disengaged will cost four times the engage. So our ability to proactively reach out to members is really important.

00;28;55;03 - 00;29;07;27

Tracy Krause

It goes back to that Population Science Management. Right. We're going to have different generations allowing them the ability to access care at different points where it intersects their life.

00;29;07;29 - 00;29;29;18

Cary Hall

Right where they are and what they want. If you want information on GigCare the website is GigCare.net. GigCare.net. The phone number 866-886-2030. 866-886-2030. Stay tuned. We'll be right back after the break with more.

00;29;29;21 - 00;29;33;28

Cary Hall

We're talking about what are you talking about, John? The upcoming what are we calling it?

00;29;34;00 - 00;29;34;28

John Stockton

the Mega Tsunami, Cary.

00;29;34;28 - 00;29;36;19

Cary Hall

The mega tsunami is coming.

00;29;36;24 - 00;29;59;14

John Stockton

Only, fewer than 20 states have finalized their ACA rates. The average projected increase for the ACA and independent of what happens with the subsidies is over 23%. A number of states are well into the 30s. For those losing subsidies, it could easily get into the 75 to 100% range. So some members losing subsidies will literally see their prices double within the ACA.

00;29;59;14 - 00;30;09;00

Cary Hall

So we think that PSM, the Population Science Management offer of the GigCare product, is an alternative that people and brokers really need to take a look at.

00;30;09;03 - 00;30;14;21

John Stockton

A variety of solutions. Aetna, Blue Cross, EPOs, PPOs that are going to meet members needs right where.

00;30;14;21 - 00;30;36;04

Cary Hall

They are welcome back. You're listening to America's Healthcare Advocate Show, broadcasting coast to coast across the USA here on the HIA Radio Network. If you have a question or problem, please feel free to reach out to me. I'm happy to help you, in any way that I can. The websites AmericasHealthcareAdvocate.com. If you are interested in the GigCare product, you want to know more about it.

00;30;36;11 - 00;30;56;14

Cary Hall

You think it might be a fit for you, or maybe might be a fit for some people in your company? If you've got 1099 workers that you can't offer any coverage to, this is a great way to introduce them to GigCare. Great way to do it. The website is GigCare.net. The phone numbers 866-886-2030. 866-886-2030.

00;30;56;18 - 00;31;17;11

Cary Hall

Somebody like the lovely Tracy Krause will be happy to help you and talk to you about the plans. Different plans, different sets of plans. You heard Tracy talk about that from Unlimited Med to our Group Benefits side to our Individual side, which is, GigCare. All right. John, let's talk a little bit about this super tsunami a little bit and kind of educate people, I guess.

00;31;17;15 - 00;31;18;25

Cary Hall

Make it easy on me. I'm sorry.

00;31;18;25 - 00;31;45;15

John Stockton

So we've had a number of conversations and most recently a large farmers co-op used the term whiplash is coming. And here's why. So fewer than 20 states have finalized their 2026 ACA rates. We have this shutdown that's really due in large part to subsidies. So people haven't seen their their state's final ACA rates. Most often. They don't know what's going to happen to the subsidies.

00;31;45;17 - 00;32;09;01

John Stockton

So people generally are unaware of this tsunami or this mega tsunami that's on the way. So the term that was used as there's going to be some whiplash when people open their ACA statement. So the thing I want to make brokers aware of is there's a lot of unknown and, naivete, if I can use that word around where things are going with the ACA.

00;32;09;03 - 00;32;14;22

John Stockton

So the beautiful thing about, our offering is they can enroll in GigCare in any month out of the year.

00;32;14;24 - 00;32;17;02

Cary Hall

So there's no open enrollment to open enrollment.

00;32;17;05 - 00;32;35;13

John Stockton

So, ACA is the all around January 1st, right? So we are very busy enrolling people right now, but certainly with this whiplash that's going to kick into effect, people can jump off the ACA whenever they want. And and we're a solution any month of the year. That's that's an important consideration that I wanted to point out.

00;32;35;17 - 00;32;45;02

Cary Hall

Yeah it is. And when the dust settles and we see where we're at with subsidies and all the rest of it, yeah. I think your comment about whiplash is, is spot on.

00;32;45;05 - 00;32;47;10

John Stockton

Yeah. So brokers need to educate what's going on.

00;32;47;12 - 00;33;01;05

Cary Hall

And again, you know, you're a broker out there. This is something you really ought to take a look at. It's going to make a difference for you. It's going to make a difference for your client and maybe their clients out there. You can't you have not been able to get in the door to talk to them because you didn't have a product to offer.

00;33;01;10 - 00;33;17;07

Cary Hall

You do now, okay. It's called GigCare. The website is GigCare.net. There are a couple of things I want to touch on, though, that are a little different. What we do. We like to say that we offer some different benefits. Benefits that are not the same as what are on the ACA plan. So we have a program called Green Imaging.

00;33;17;10 - 00;33;33;17

Cary Hall

And if you need an MRI or a CT scan, you can get a voucher from us from Green Imaging. And you're going to go to an independent imaging center. And you're going to get that MRI and that CT scan done, and you're not going to pay anything for it. That's right. No deductible, no co-insurance and no co-pay.

00;33;33;21 - 00;33;54;15

Cary Hall

That's part of what we do. We're different than ACA because we can do things that the ACA plans can't do. Some of the other things we do we do drug importation. So we have three different programs we can help people with on drug importation, and foundational assistance, if they have a very expensive med like a growth hormone, that they that they can't afford.

00;33;54;22 - 00;34;10;20

Cary Hall

We have a foundational assistance program. You know, who does all that paperwork, all of our nurses at Script Aid. We don't put that back on the client as Tracy says, we're there to serve the member, and that's what we do. So those are a couple of things very different about us. We talked a little bit about mylivedoc.

00;34;10;20 - 00;34;30;15

Cary Hall

We think it's a great program. Again, there is no copay when you use mylivedoc, whether it's mental health, urgent care or just primary care, there is no co-pay. And then we have another program for diabetes. And if you're a diabetic, we're going to enroll you and Diet Thrive. That program is going to make sure you got your A1C.

00;34;30;15 - 00;34;51;06

Cary Hall

They're going to make sure if you're taking metformin is being drop shipped to your door, or you're getting it and you're taking your medication so that we're managing the disease. You know, John, how important is it to manage chronic disease in terms of, you know, giving people what they need, but being able to keep cost under control because you're being proactive, not reactive?

00;34;51;07 - 00;34;51;19

Cary Hall

Yeah.

00;34;51;22 - 00;35;16;14

John Stockton

No, that's, for us to help our clients and our members to be engaged, Cary, doing the things they know they're supposed to be doing. We’re the most obese country in the world. So coming alongside plan sponsors, employers, members to really help them engage in a path to a journey of wellness is extremely important. And what we do now is going to show when we get further down the path in our years.

00;35;16;16 - 00;35;43;21

Cary Hall

Yeah, it is, and it's critically important that we do this in a way that serves people, and gives them that opportunity for these plans that are going to make a difference for them because they are different. Yeah, we're we're serving different pieces in the marketplace. And we think that if you're one of those folks out there looking for this kind of coverage, and you, as John has said and as Tracy has said, you know, there is a maga tsunami on the coming. It's going to have a tremendous impact in this country on a lot of folks.

00;35;43;23 - 00;36;03;08

Cary Hall

Our plans, we think are more affordable. You'll see that when you actually look at the plans and different plan designs, they're more flexible. We have far more designs and opportunities than what are offered on ACA because we can because we're regulated differently than ACA is. We're regulated by the Department of Labor under the ERISA laws.

00;36;03;13 - 00;36;25;12

Cary Hall

So we're compliant with all of that. But it makes it different for us in terms of the product we offer. So if you're the broker out there and you're looking for something to serve a marketplace, and I'll give you a couple of examples we have, what do we have five different initiatives with major real estate firms going on right now, from Reese Nichols to, I mean, go down the list, Better Homes and Gardens.

00;36;25;12 - 00;36;42;26

Cary Hall

So we've got a whole series of, and we've got associations of realtors where they're the Missouri Association or the Kansas or the Iowa, whatever it is. Okay, that are happy to have this product because these realtors, you know, have been on ACA and I'll give you an example one, before we close out the show here, the gentleman was 52 years old.

00;36;42;26 - 00;37;04;13

Cary Hall

He worked at Reese Nichols. He has a wife and one child is paying $3,100 a month. He moved to the GigCare plan on an HSA with a $5,500 deductible, and he dropped his cost of $1,400 a month. Better plan, better price, better opportunities. That's what GigCare offers. If you want information on it, go to the website GigCare.net.

00;37;04;16 - 00;37;29;21

Cary Hall

That's GigCare net. The phone number 866-886-2030. 866-886-2030. If you're a broker, you owe it to yourself to take a look at this. If you're an employer out there and you've got those 1099 employees and you have nothing to offer them, this is an opportunity. If you're an association looking for a way to offer something to the members of your association, this is a great opportunity.

00;37;29;21 - 00;37;35;17

Cary Hall

And we've got a lot of associations now, John, that are that are engaging with us to offer this plan across the country.

00;37;35;24 - 00;37;39;12

John Stockton

Yeah. Again Mega Tsunmi, take the high ground and we’re the high ground Cary.

00;37;39;13 - 00;37;41;17

Cary Hall

Yeah, we do believe we are the high ground. Okay.

00;37;41;17 - 00;37;48;11

Tracy Krause

Population Science Management has those plans that we're going to fit each one of your individual client's needs.

00;37;48;17 - 00;38;07;01

Cary Hall

So again and I urge you, if you want information go to the website gigcare.net or call 866-886-2030. And now I leave you with this thought from Albert Einstein, the one who follows the crowd they usually get no further than the crowd, the one who walks alone is likely to find himself in places no one has ever been.

00;38;07;03 - 00;38;24;16

Cary Hall

Remember, friends, it's a funny thing about life. If you refuse to accept anything but the very best, you most often get it. Thank you for listening to America's Healthcare Advocate Show broadcasting coast to coast across the USA. Goodbye, America.

00;38;24;19 - 00;38;31;13

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