By Tom Strangstalien

Insurance Advisor with WisMed Assure

September is Life Insurance Awareness Month. All month long, as I sat sipping my morning coffee, I reflected on how many times I’ve experienced the life changing impact of life insurance.

Even though I’ve been a life insurance agent for more than two decades, there are times when even I take for granted this life changing tool within our financial tool box. There are dozens of stories I can tell about how life insurance has truly been a difference maker in the lives of so many. Four of these stories stand out in particular because they had a direct personal impact on me.

Rene’s Home

Rene designed a plan, utilizing universal life insurance to potentially pay off the mortgage on her home early. The policy insured the lives of her and her husband jointly, and we funded the policy in such a way to grow the cash value quickly, yet be friendly to the family budget. 

One day, John mentioned to Rene that he had a lump on the back of his tongue which was bothering him. Being a nurse, Rene advised John, that he probably should get it checked out by their Doctor.  John battled cancer for the next four months. The family took care of him at home, until the day came when John passed away in his sleep.

 I received a call from Rene months later. Choking back tears, she told me because of the plan that was intended to pay the mortgage off early, the life insurance allowed her to remain in the home with her two daughters. She went on to tell me that she was going back to college to advance her status to a Registered Nurse. After much expression of gratitude and profuse thanks, she ended by telling me I helped the family change their life. Speechless at first, I finally said, “Yes, life insurance is a game changer.” 

Rene is debt free, cherishing her career as a registered nurse, while her two daughters attend college in Eau Claire.

Don’s Hockey Legacy

My son is a hockey player. Our small-town hockey rink was actually a make shift park shelter. I cherish the times that we set up the chiller to make the ice for the season, construct the walls, bring in the bleachers, and keep the rink maintained throughout the winter season. Our rink was viewed as a joke, and with a little bit of disdain by our fellow competitors throughout the state. 

However, we were really good. In fact, we took home many tournament trophies, state youth championship titles, and as a high school advanced to the state tournament on multiple occasions. How amazing would it be if we had a real rink? In discussing ideas with the parent committee on how to pursue such an aggressive endeavor, I suggested we approach community benefactors. 

I proposed an idea to Don, a very successful businessman in the community, that we fund a $5 million life insurance policy to someday create a community hockey arena and event center, bearing his family’s name. After deliberation with his tax accountant, he learned the charitable pursuit would provide a large benefit to him “tax wise”. His family stands proud of their patriarch, as they regularly witness the use of the family named facility. Don made a difference, and his legacy lives on.

Life Can Go On

Wayne would do anything for me, and pretty much for everyone. 

He helped me put up my tree stands for deer hunting every season. He taught me the ropes to hunt for ginseng in the fall and morel mushrooms in the spring. When the Brewers would play during the summer, I would frequently see Wayne and Carla’s truck pulling into our driveway, with their daughter Carlie in tow, to have a cold one, watch the Brewers, and do our best to discover the meaning of life. 

As with all of my friends, I encouraged Wayne to purchase a term life insurance policy. Their budget was tight, but we were able to formulate a significant amount of coverage with an affordable price. 

On a really soggy rainy day in the spring of 2016, Wayne, Carla, and Carlie ventured out to Carla’s mother’s land, located in Iowa. They would frequently take these trips, and while Carla visited with her mother, Wayne would maintain the family farm.

Shortly after crossing the bridge into Minnesota, and initiating the trip south to the Iowa border, Carla saw a tree give way on the bluff above. There was no time to react. The tree landed on the roof of the truck, killing Wayne instantly, breaking Carla’s neck, and leaving Carlie with head trauma and face lacerations. 

Carla was now a single parent, in a neck brace for months. Carlie recovered, cherishing the moments with her father and hero. I stood silent at the funeral, as the military salute and folding of the flag took place. Doing their best to emulate Wayne, the family stood tall, confident, and proud. Life would go on, and they would be “ok”. 

My Friend Randy

Randy was my best friend. We went to high school together, were college roommates for four years, and his brother married my sister. I recruited Randy to join our team in the “insurance business”. After some hesitation, Randy joined the team, and we spent many nights together learning the business. His on the job training involved writing a policy on himself (encouraged by me). 

I’ll never forget the call I received from my mother one beautiful April spring morning. She uttered, “Are you sitting down?” As I sipped my morning coffee at my kitchen table, I replied an affirmative yes. “I have some news. Your friend Randy woke up yesterday, and was going to read the morning paper, but he couldn’t. He was diagnosed with an inoperable brain tumor, and has about 6 months to live.” The words shook me to my core.

I took Randy shopping for his groceries one day. That was the last time I saw him. Six months from the date of the initial diagnosis, Randy was gone. He left behind two children, ages 5 and 7, and his wife Michelle who was a nurse. Michelle cried when she got the check for the life insurance. She was able to purchase a home for the family, continue her career in the medical field, and eventually put both boys through college.

Are You Aware?

Heaven forbid anything happens to you or your loved ones. But, wishing is not a plan. If you would like to explore and discover the very best possible options to fit your needs, I am always available. Please contact me with any questions or concerns you may have.

Tom Strangstalien

Insurance Advisor

WisMed Assure

Direct:  608-442-3730

Cell:  608-304-1579

Income-Driven Repayment Plans

The ins, outs, upsides, and downsides you need to know

By Rufus Sweeney

Looking forward to residency also means looking forward to repaying your student loans.
Sounds like fun… doesn’t it?

OK, perhaps not a lot of fun, but unavoidable. So, to reduce your stress and feel good about your financial progress, you need to make the best choice. And, making the best choice for how to repay your student loans takes a little thinking.

Before we look at the different types of repayment plans here are two important things to remember:

  1. It’s critical to start loan repayment while in residency rather than use deferment or forbearance. This will save you thousands.
  2. In many cases, you can switch repayment plans if your financial situation changes. This relieves some of the uncertainty you may feel when making your initial choice.

Now, the basic premise of income-driven repayment (IDR) plans is simple; you repay your federal student loans based on your ability to pay.

Here are your choices:

  • Standard repayment plan
  • Graduated repayment plan
  • Extended repayment plan
  • Income-driven repayment plans (Yes, there’s more than one!)

Phew! Seems complicated… and it is, but here are some basic definitions to help you figure out how you can best navigate the loan repayment landscape.

Standard repayment plan: You pay off your loans in 10 years. Your monthly payments are fixed based on adding the amount you owe to the projected interest and dividing by 120. WARNING: If you do not choose another type of repayment plan, you will be automatically enrolled in this repayment plan

As a resident, because your monthly payments will most likely be more than you can afford, this is not the way to go.

Graduated repayment plan: These also run for 10 years, but monthly payments start out low and increase every two years. But, as with standard plans, even the lower monthly payments are still likely higher than you can afford on a resident’s salary.

Extended repayment plan: Now we’re looking at the long term. With this type of plan, you’re facing 25 years of fixed or graduated payments. This type of plan is good if you don’t qualify for an income-driven repayment plan. And, sorry to do this to you, but even thinking about this type of plan is a waste of time because, as a resident, you qualify for income-driven repayment plans.

Income-driven repayment plans: These plans peg the size of your monthly payment to your income.

The four types are:

  • Pay-As-You-Earn (PAYE)
  • Revised-Pay-As-You-Earn (REPAYE),
  • Income-Based Repayment (IBR)
  • Income-Contingent Repayment (ICR)

Generally speaking, these plans cap monthly payments at 10% of your discretionary income. (Very simply, your discretionary income is your income minus whatever the poverty line is for your family.)

Low income = low payments. Your payment size is recalculated every year after you file taxes. The good (great?) news is that after 20 to 25 years, what remains of your student loans is forgiven. (Next blog we’ll look at public service loan forgiveness; which are forgiven in only 10 years.)

As you have probably realized, IDR plans work well for residents who are trying to get by on a $60,000 salary and owe a lot of money (roughly $50,000 or more).


PAYE differs from REPAYE in two significant ways.

First, to qualify for PAYE you have to prove you can’t afford to make the payments a standard 10-year repayment plan requires. REPAYE doesn’t ask for this proof… no matter what your salary, your payments will never be more than 10% of discretionary income.

Secondly, PAYE is limited to the repayment of William D. Ford Direct Loans received after Oct. 1, 2007 and funds disbursed on or after Oct. 1, 2011. These loans include Direct Loans, subsidized and unsubsidized, Graduate PLUS loans and Direct Consolidation Loans made after Oct. 1, 2011, unless they include Direct or FFEL loans made after Oct. 1, 2007. Phew!

REPAYE is available to people who borrowed from the Direct Loan program, except for parents who took out PLUS loans. You qualify for REPAYE no matter when you took out your loan and as long as you borrowed from the list of qualified William D. Ford Federal Direct Loan programs.

A major benefit of REPAYE is you remain eligible for the Public Service Loan Forgiveness program.

Payments on the REPAYE program are adjusted every year based on income and family size. If you file your taxes separately, PAYE won’t take your spouse’s income into account when calculating your payments. With REPAYE, your spouse’s income is taken into account.

The best part of these programs is that after 20 years of on-time loan payments, your debt is forgiven.

Income-Based Repayment (IBR)

Income-based repayment (IBR) is another income-driven repayment plan that caps monthly payments at 10 to 15% of discretionary income. This type of plan is an option if you don’t qualify for PAYE and don’t want to include your spouse’s income into your discretionary income. (That said, almost every resident qualifies for PAYE.)

Income-Contingent Repayment (ICR)

This type of repayment plan work well if you are paying back student loans your parents took out on your behalf. They also work well for parents themselves who need an affordable way to pay back the loans they took for you. If you aren’t paying back loans from your kids or loans from your parents, ICR is probably not the plan for you.

A final word on flexibility

You can switch from on repayment plan to another. For example, if you graduated recently, you could choose REPAYE to take advantage of the government interest subsidy. Then, if you’re lucky enough to marry someone with a high income, you could switch to PAYE to avoid having your spouse’s income included in your monthly payment calculations. And, sometime down the road, you may quit your income-driven plan altogether because you want to make larger payments.

If you need help managing your debt, one of your best resources is your financial aid officer. And, I highly recommend visiting the White Coat Investor website. It’s a great source for guidance on how to acquire and manage the “good” forms of debt.

Financial Success Requires Offense and Defense

…and, defense may not be what you think it is

By Tom Strangstalien, Financial Protection Advisor

Offense, financially speaking, is focused on growth. Defense is focused on keeping what you have. Pretty simple concepts all-in-all. However, each has nuances that vary depending on your tolerance for risk, age, retirement goals, current and future lifestyle goals, and of course, income.

Income itself is one of your offensive tools. This includes the income you earn from working and passive income earned by investments. The other form of offense shows up in investment portfolio design and is generally about choosing assets or combinations of assets that have a high probability for growth… and generally, a greater degree of risk. And, of course, you can also play defense in your portfolio by choosing assets that are slower growing and less risky. The proportion of offense and defense in your portfolio is dependent on the variables mentioned above. This is where the advice of a professional investment advisor who understands your current situation, along with your goals and desires, is essential to your success.

As to other forms of defense, well that’s where I have spent my life helping people figure out. For example, during your earning years, your salary and other earned income is your most formidable offensive asset. But what happens to your plans if due to illness, injury or – God forbid – death, reduces or eliminates your income? How will you and your family maintain your standard of living? How will you be able to continue pursuing your retirement plans?

A substantial market for income replacement insurance has steadily developed for decades. (I include life insurance in this definition as it provides income for your family if you die.) There are as many options as there are individuals who need this type of defense, which means you have the opportunity to choose the type of insurance that exactly fits your current situation (including budget), and future goals.

A general feeling within the insurance industry, is that once a couple reaches the age of 55, there is substantial probability that one of them will need a form of long term care during their lifetime.   I have personally witnessed this within couples that I have worked with throughout my career.  That’s where another form of defense plays an exceptionally important role in protecting your immediate financial security and the integrity of your estate.

Now, like income protection insurance, there are many long-term care insurance options. To choose the option that’s right for you, you have to take into consideration how much tax you are paying and will pay. Again, the nuances can be quite subtle, but generally speaking, an experienced advisor will be able to show you all the ins and outs of the insurance products available.

One thing is for certain; the best time to do this type of planning and make your decisions is now. The sooner the better because, as you age, your options may become more limited, and for certain, the cost will increase.

If you would like a personalized tour of all the options that are right for where you are today and where you want to be in the future, contact me. I look forward to being your defensive coach.

Tom Strangstalien 

Direct:  608-442-3730

Cell:  608-304-1579

Look out! Open Enrollment Is Upon Us!

Never fear… WisMed is here

By Chris Noffke, GBDS – VP of Employee Benefits

November is coming and so too are your updated employee health plan costs… if the carriers are up to speed!

Regardless, it is time to start thinking about and planning for open enrollment. In addition to being prepared so that employees have the time, information, and support they need to select a plan that best fits their needs, here are some important changes you need to know;

  • 2021 affordability percentage is 9.83%, up from 9.78% (This applies to groups of 50 or more employees)
  • Out of Pocket Maximums for 2021: $8,550 for self-only coverage and $17,100 for Family
  • HDHP and HSA Limits for 2021 (see chart)

Compliance, compliance, compliance… talk about fun!

In all seriousness, here is a reminder of when to submit your ACA Disclosures and Notices:

  • Special Enrollment Notice: Initial Eligibility and each Open Enrollment and also must be in SPD (Summary Plan Description).
  • SBCs (Summary of Benefits and Coverage): Required 30 days prior to new plan. Must be provided during each annual enrollment. If an employee must enroll to continue coverage, the SBC must be provided when open enrollment materials are distributed.
  • CHIP Notice: Annually, before beginning of plan year. Recommend to include with Open Enrollment materials and upon initial eligibility.
  • Medicare Part D Creditability: Must be sent before October 15, regardless of your plan year.
  • Women’s Health and Cancer Rights Act (WHCRA): Annually & upon initial enrollment / Usually sent at Open Enrollment.

Market Updates

General opinion on this year’s premium increase range widely between 4 and 10 percent for group benefits.

As to trends in plan design in response to COVID, a survey conducted by Mercer in June found that 37 percent of employers do not anticipate adjusting benefits for 2021. It also found that 48 percent are taking a wait and see approach.

While waiting to see what plans will actually cost, I believe we need to be mindful of what’s almost certain to occur in 2021. Many plans have made gains this year because employees are deferring elective care, but, as COVID releases its grip, it will almost certainly result in a much higher than normal plan usage in 2021.

Some of you may have an opportunity to lower costs if you are willing to change insurance companies. But, look at any “gift horse” very carefully, you could be facing an even larger increase than normal next year if you switch to a company that is trying to grab marketing share.  If you are uncertain what to do, but find yourself in a situation where status quo means accepting a significant increase, we should talk.

And, if you would like to discuss how you can prepare now for what’s ahead, contact me.

Open Enrollment Safety

We will still be hosting town hall meetings but will be doing so with COVID-19 safety in mind. 

Please contact me to discuss arrangements for virtual enrollment meetings for your employees.

Chris Noffke

608.442.3734 direct

WisMed Increases Your MPL Choices

More options available even while insurers brace for uncertainty

By Shawna Bertalot, CIC, ACI, President WisMed Assure

A recently published report by A.M. Best says medical professional liability (MPL) insurance providers continue to experience decreased profitability. The rating firm is maintaining its negative rating for the segment and reports a growing amount of uncertainty due to potential increases in claims coupled with premium refunds, both stemming from the COVID crisis.

Even before COVID-19 swept through the country, the market was hardening – which means premiums were on the rise and terms and conditions were become more stringent. (See September 2019 Antidote Article “History Repeats Itself”)

While insurance companies continue to assess what their products cover and the cost of coverage, governments are introducing new laws that can directly and indirectly impact risk and insurance. It is a constantly evolving situation which we are closely monitoring.

To better serve the medical profession, our team has sought out alternative carriers and products to ensure you have the greatest amount of choice possible. Some of the new options we provide are directly related to the changes care givers have had to make due to the coronavirus.  (E.g.: Retired physicians returning to work have new options. Physicians who have increased their telemedicine activity have new options.)

Exploring Options:  What to Look For

When choosing an MPL insurance policy, or when replacing or updating your existing policy, it is easy to put too much focus on premium costs. That is certainly understandable, but it is not the only criteria you should be basing your decision on.  The most important thing to focus on is choosing the broadest coverage with a financially strong insurance carrier dedicated to the MPL market and excellent track record in claims handling.

Your Best Bet

To get what you need, and feel confident about the decisions you make, your best bet is to work with an experienced insurance advisor. The WisMed Assure advisory team has many decades of experience and a commitment to be your financial partner for life. We know your world because we only serve physicians and medical professionals. Plus, we are in it for the long haul as our profits contribute to The Wisconsin Medical Society’s ability to fulfill its mission: To improve the health of the people of Wisconsin by supporting and strengthening physicians’ ability to practice high-quality patient care in a changing environment.

If you have questions, want to learn more, or concerns to address, contact WisMed Assure today.


Injured Patients and Families Compensation Fund Announces Premium Holiday

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Injured Patients and Families Compensation Fund Announces Premium Holiday

On Wednesday, June 17, 2020, the Injured Patients and Families Compensation Fund (fund) approved waiving the upcoming fiscal year’s premiums for physicians, CRNAs and hospitals enrolled in the fund.

The Society has been working hard to find ways to assist its membership during these unprecedented times. The premium holiday was originally requested by the Society and endorsed by the fund’s Actuarial and Underwriting and Finance/Investment/Audit committees before it was approved by the Board. The premium holiday will be in effect from July 1, 2020 through June 30, 2021. Read More

MPL Market + COVID-19 = What Next?

The COVID-19 crisis will add pressure to an already “stressed out” underwriting environment.

Carriers are now responding to demands of COVID-19 with premium relief and underwriting flexibility (e.g. waiving requests for supplemental information on telemedicine or cross-state boarder practice). This lowers their premium base and handicaps underwriting.

“In this environment, I’ve never been more acutely aware of our mission at the Wisconsin Medical Society and WisMed Assure and I am proud of how we and our community of physicians have responded,” says Shawna Bertalot, WisMed Assure President.  Read More
Shawna Bertalot is the president of the WisMed Assure agency. With her strong leadership skills and knowledge of the industry, our skilled team of agents are motivated and well prepared to find solutions for our clients. 

Navigating Testing in a COVID Environment

By Chris Noffke, GBDS – VP of Employee Benefits

Navigating insurance benefits is complex and confusing for consumers and business owners alike. People seeking benefits are expected to understand insurance terms like deductibles, coinsurance, out of pocket limits, annual out of pocket limits (yes this can have a different maximum risk amount) and many others.

On top of that, you now have to understand the ins and outs of preventative care coverages and COVID related no-cost, shared-cost coverages.  Read More


Chris Noffke: Vice President, Employee Benefits

I am pleased to announce the promotion of Chris Noffke from Director of Group Benefits to Vice President, Employee Benefits. Chris has been with WisMed Assure for four years and has worked as an insurance advisor for more than 15 years.

In his role as vice president, Chris will focus on advancing WisMed Assure’s ability to deliver superior employee benefit solutions and service to an ever-growing number of healthcare providers.

Chris has already played a key role in the creation of several important initiatives and programs including the association health plan, a pooled disability program, and the improvement of the pricing and value of our dental program. He is currently working on the development of a national medical cooperative and a national association health plan.

Prior to joining WisMed Assure, Chris held positions at WPS, EPIC Life, Group Health Cooperative of South-Central Wisconsin and Ameritas Group, as well as operating his own insurance agency. He has completed the National Association of Health Underwriters Voluntary/Worksite Certification and holds a Group Benefit Disability Specialist (GBDS) designation and is studying to become a Certified Self-Funding Specialist (CSFS).

Chris has a Bachelor of Arts degree from the University of Nebraska.

On behalf of the entire WisMed Assure team, I congratulate Chris on reaching this important milestone and look forward to supporting his continued success.

Shawna Bertalot, CIC, ACI, President
Society Steps Up With PPE Assistance
The Wisconsin Medical Society is proud to provide a way for Wisconsin health care professionals to order PPE. The Society coordinated this opportunity with a bulk supplier and is not earning a profit from these sales. 

The Society continues to experience a wonderful response and is happy to announce the recent addition of face shields and a second gown option to the product selection. There is a $500 minimum, with no maximum and product must be picked up in Madison.

To learn more or order, click here.

Please share with any health care workers who need PPE! The next bulk order will soon be placed via ActionPPE.
AS of mid-June, 46 organizations have placed orders for:
  • 38,450 masks
  • 10,000 KN95 masks
  • 2,970 gowns
  • 210 ISO gowns
  • 100 face shields
The Society is happy to be able to provide this service to the physicians and health care organizations in our great state. Please continue to check the Society’s website for updates to the PPE process.

Attend virtually on August 12th.

Physicians interested in being a part of lowering cost, increasing access and improving outcomes in healthcare cannot miss OnRamp Healthcare Conference (OnRamp). The conference will be online this year on August 12 and complimentary registration is currently available via the OnRamp website.

“The Wisconsin Medical Society has been serving the changing needs of physicians for more than 178 years and witnessed the ever-increasing role technology plays in health care,” says WisMed Assure president Shawna Bertalot, CIC, ACI. “OnRamp is a chance for physicians to have a seat at the table in what the next big innovation will be and, most importantly, how it will help them deliver low cost, quality patient care… and maybe, the next innovation won’t have to wait for a pandemic to become mainstream.”

Tim Bartholow, MD, Wisconsin Medical Society member and VP and Chief Medical Officer at WEA Trust, echoed Bertalot’s statement. “Technology, the right technology, is the physician’s friend. For example, with the explosive demand for telemedicine, what was once optional and even frowned upon, has now been accepted as a viable option for delivering patient care. The physician’s wisdom is being delivered directly to the patient… without the need for fancy buildings, waiting rooms and the traditional factors that can interfere with, or even drown out, essential patient-physician conversations.”

For more information visit the OnRamp website or contact your Wismed Assure representative.

We’re growing!
Insurance Advisor joins the WisMed team

At WisMed Assure, we are always looking for and developing new and better ways to serve the Wisconsin medical community. This includes developing our team of dedicated professionals through education, training, and, when needed, hiring proven expertise.

We are delighted to announce Tom Strangstalien has joined our team to bolster our financial services capabilities. Tom specializes in individual financial protection including life, disability and long-term care insurance.

Tom has over 25 years of experience in the financial-protection business. He believes clients should be treated in the same way he and his family would like to be treated and that building relationships is crucial to delivering the best possible service and value.

Tom attended Viterbo University, majoring in Business Administration and Finance, graduating with honors, Magna Cum Laude. Throughout his career, Tom has earned numerous awards and recognition, including top of the table at several insurance companies, and becoming a member of the Million Dollar Round Table.

When Tom is not busy protecting the financial wellbeing of his clients, he enjoys traveling and seeking out new experiences with his wife and their four children. On any given weekend, you can find Tom, fishing, hunting, or hiking and creating memories that will become tall fish tales, some even true.

We are excited to welcome Tom to the WisMed Assure team and look forward to working with him to assure our clients’ financial health and security.

Wisconsin Medical Society Declares Racism to be a Publish Health Crisis

Racism is a constant threat to health, medical care and longevity in America. The Wisconsin Medical Society, driven by its mission to improve the health of the people of Wisconsin, declares racism to be a Public Health Crisis and calls for equity in health.

Racism threatens health. Racism worsens the social determinants of health, including housing, employment, education, community and neighborhood, food and medical care. Poor housing, including homelessness, results in illnesses such as diabetes and asthma. Unemployment increases heart disease risks and overall mortality; poor education increases death from diabetes; physical space loss for exercise increases childhood obesity; and food deserts significantly increase African-American obesity. The greatest health threat faced today in COVID-19 has further revealed these profound disparities demonstrated by the disproportionate mortality in communities of color.

The human toll is destructive and untenable. To move forward, we must take a stand against racism. In doing so, we stand in solidarity with organizations across the state and our country condemning racism, injustice, and health disparities.
The Society, along with many other healthcare organizations, is taking a strong stand and has identified seven key recommendations for change. You can learn more here.

Different Kinds of Debt: The Good, the Bad, and the Just-Don’t-Do-It!

By Rufus Sweeney

Amassing a considerable amount of debt during medical school is “situation normal” for practically every medical student. Even though debt is rarely seen as a good thing, you need to know the difference between good debt, bad debt, and debt to be avoided at all cost.

Choosing wisely now makes paying off your debt much easier. Read More

Register Now for Wisconsin Medical Society Virtual Town Halls

The Wisconsin Medical Society is hosting a series of virtual town halls.

Governor Tony Evers will join the Wisconsin Medical Society at the next Town Hall on Wednesday, June 24 at 12:15 p.m.

Governor Evers will speak about the impact of the COVID-19 pandemic on health care as well as meeting the challenge of addressing health disparities in Wisconsin.

This is a weekly series with additional town halls on July 1  and 8. Each session will feature a different guest speaker. You only need to register once and you will be signed up for the entire series.

NOTE: The Society’s Virtual Town Hall sessions are not recorded, and advanced registration is required.
We are monitoring the ongoing developments for your insurance coverage options. For all the latest have a look at our Covid-19 resource page here.
The Antidote is a quarterly newsletter from your Financial Partner for Life. Each edition will keep you up to date on the latest industry trends and products and services that will help reduce your financial stress. 
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Different Kinds of Debt: The Good, the Bad, and the Just-Don’t-Do-It!

By Rufus Sweeney

Amassing a considerable amount of debt during medical school is “situation normal” for practically every medical student. Even though debt is rarely seen as a good thing, you need to know the difference between good debt, bad debt, and debt to be avoided at all cost.

Choosing wisely now makes paying off your debt much easier.

In the category of “Just-Don’t-Do-It”, all sorts of credit cards are available and in many cases, actively promoted to medical students with special offers that include an interest free period, cash back on purchases, and all too easy sign up terms. But once that interest free introductory offer ends, you’re on the hook for anywhere from 12 to 25 percent interest on any balance you carry from month to month.

When you use a credit card to finance your lifestyle choices or, worse case, pay for essentials without a plan for paying off your balance each month, you’re playing with financial fire.

The “bad” in comparison to credit card debt, doesn’t look all that bad, but still with interest rates ranging from six to 10%, unsubsidized student loans are an expensive choice.

The “good” are those loans with the lowest possible interest. For example, interest rates for institutional loans from medical schools range from four to five percent. If low interest was the only criteria for determining “good” debt, then a mortgage at three to five percent and car loans at four to five percent would also fall into this category. That said, check out my previous blogs and podcasts on the pros and cons of buying a home and the reasons why it is a good idea to live like a resident, even after you become an attending physician.

Paying the piper

No conversation about interest rates is complete without a word or two about repaying debt.

Generally speaking, there are two popular methods: the snowball method and the avalanche method.

Popular financial expert Dave Ramsey recommends the snowball method because he says, “… personal finance is 20% head knowledge and 80% behavior. You need some quick wins in order to stay pumped enough to get out of debt completely.”

Here’s how it works:

Step 1: List your debts from smallest to largest regardless of interest rate
Step 2: Make minimum payments on all your debts except the smallest
Step 3: Pay as much as possible on your smallest debt
Step 4: Repeat until each debt is paid in full

Here’s an example using four different debts:

  1. $500 medical bill—$50 payment
  2. $2,500 credit card debt—$63 payment
  3. $7,000 car loan—$135 payment
  4. $10,000 student loan—$96 payment

Using the snowball method, you would make minimum payments on everything except the medical bill. You would pay as much as possible each month on the medical bill until it is paid off.  You would then take the money you used for the minimum payment on the medical bill, plus as much extra as you can afford and use it to pay off your credit card debt. As soon as that debt is paid, you take all the money you previously used to pay the medical bill and credit card debt off and apply it to your car loan.

By the time you are ready to pay off your student loan, you’ve got a pretty big debt repayment snowball working for you.

The avalanche method takes a more practical approach… at least mathematically speaking.  You make minimum payments on all debt and use any remaining money to pay off the debt with the highest interest rate. Like I said, this method is a more practical approach because it allows you to save hundreds of dollars in interest payments and reduce the time it takes to pay off all your debt.

When it comes to choosing which method to use, remember what Dave Ramsey says… “personal finance is 20% head knowledge and 80% behavior”.

In my next blog, we will explore the different ways in which interest rates are calculated.

If you need help managing your debt, one of your best resources is your financial aid officer. And, I highly recommend visiting the White Coat Investor website. It’s a great source for guidance on how to acquire and manage the “good” forms of debt.

Navigating Testing in a COVID Environment

By Chris Noffke, GBDS – VP of Employee Benefits

Navigating insurance benefits is complex and confusing for consumers and business owners alike. Today’s insurance landscape requires people seeking benefits to understand insurance terms like deductibles, coinsurance, out of pocket limits, annual out of pocket limits (yes this can be different caps) and many others.

On top of that, you now have to understand the ins and outs of preventative care coverages and COVID related no-cost, shared-cost coverages.

Currently most insurers are covering the COVID tests, antibody testing, and treatment with no cost share. But be aware, these 100% covered costs will eventually become the patient’s responsibility. Some testing may continue to be covered at no cost to the patient but you may be billed if you go outside of your network or don’t have an approved reason for testing.

We can begin to understand why by looking at the cost of one of these tests. A local PPO (preferred provider organization) reported that they have seen the cost of COVID Antibody testing (Codes 86328 and 86769) range from $23 – $1,023.92, which is one of the major issues with understanding your cost shares.

So, while this test may be covered based on current legislation, when will it no longer be covered? As of right now, there is a lot of speculation that once the “state of emergency” ends, you may see no cost end too.

Currently, to get an antibody test done, it needs to be ordered by a healthcare professional in an office visit, urgent care room or emergency room. Although there are some guidelines for how out of network visits will be covered, patients are sure to see costs shifted to them.

What does the future hold?

When I think about our healthcare future and how COVID-19 will impact the cost of care, it causes a significant sense of concern. With so many people avoiding seeing a physician during social distancing, we should anticipate a surge of chronic illnesses with higher than average claims costs. Staying home means those with anxiety, depression and obesity may be spending even more of their time on couches and this means less physical activities and socialization.

A recent report by Milliman – the highly respected risk management consulting firm – states, “We expect an increase in costs after the Pandemic due to deferred care and pent-up demand… The estimate of services deferred to 2021 is beyond the scope of this paper, but those costs are likely to be very significant.” The report says that ‘very significant’ is an understatement, as it speculates there will be at least $75 billion and as much as $575 billion in deferred care.

And that’s for non-COVID care! Another analysis, commissioned by America’s Health Insurance Plans, estimates that total costs of COVID-19 for commercially insured individuals could range from $44.6 billion to $438 billion over the next two years.

Arriving at a clear conclusion is impossible given the volatility of our times. But, what we can do is work together to protect each other while aggressively looking for ways we can collaborate to protect our healthcare future.

For a comprehensive look at COVID-19 related insurance coverage, check out this Health Affairs article by Katie Keith and take a look at Wismed Assure’s Covid-19 Updates page for added tools and resources.

MPL Market + COVID-19 = What Next?

How the pandemic may impact an already hardening market

Consider the degree of uncertainty COVID-19 has introduced while reading this statement by Tom Baker, a University of Pennsylvania Law School professor.

Baker says, “understanding how insurers define cost is, key to understanding the insurance under-writing cycle… when insurers set their prices, most of the costs of the insurance coverage will be incurred only in the future. As a result, insurers constantly have to imagine the future to decide how to price their products today. This situation creates a remarkably high degree of uncertainty. This uncertainty about insurance costs is the fuel that drives the underwriting cycle.”

Baker’s statement was published in a three-part Antidote series on the hardening of Medical Professional Liability (MPL) insurance market months before the world was turned upside down by the pandemic we are still finding our way through.

At the time, no rate-making actuary could imagine a worldwide pandemic would cause such a massive disruption of healthcare delivery, consume the energy and resources of the healthcare system while simultaneously causing many physicians, clinics and hospitals to incur an unprecedented loss of patients and revenue. And it is not over yet.

Underwriting is “stressed out”

The COVID-19 crisis will add pressure to an already “stressed out” underwriting environment. On a macro level, MPL insurance carriers are experiencing higher loss ratios that force increased premiums and more judicious underwriting in an effort to lower claims costs. This is what is referred to as a “Hard Market.” Carriers are now responding to demands of COVID-19 with premium relief and underwriting flexibility (e.g. waiving requests for supplemental information on telemedicine or cross-state boarder practice). This lowers their premium base and handicaps underwriting. The story becomes much more complicated when you consider insurance carriers are collecting premiums now to pay claims that will be made in the future. 

Susan Forray, FACS, MAAA, Principal and Consulting Actuary with Milliman, published an article in May in which she examines the complexity of the COVID-19 impact, writing, “Actuaries are accustomed to pricing future costs based on past losses. But the COVID-19 pandemic has taught us the past is only one piece of data in making these estimates. Modeling the coronavirus pandemic itself is difficult, but modeling MPL costs affected by this pandemic is exacerbated by tort law changes, variations in effect among specialties, and an apparent reduction in current claims that may prove to be only a delay contributing to an increase in future claim frequency.”

What should you do now?

Continue to look for stability and security by renewing your coverage with a financially strong insurer; a long-term player committed to the MPL insurance marketplace. This is where an experienced broker can play a key role in helping you understand the quality of the insurers willing to do business with you and help you navigate your options.

“In this environment, I’ve never been more acutely aware of our mission at the Wisconsin Medical Society and WisMed Assure and I am proud of how we and our community of physicians have responded,” says Shawna Bertalot, WisMed Assure President.  

Please contact Shawna Bertalot to discuss this article or your insurance needs and concerns.

Shawna Bertalot, CIC, ACI, President WisMed Assure

Injured Patients and Families Compensation Fund announces premium holiday

On Wednesday, June 17, 2020, the Injured Patients and Families Compensation Fund (fund) approved waiving the upcoming fiscal year’s premiums for physicians, CRNAs and hospitals enrolled in the fund.

The Society has been working hard to find ways to assist its membership during these unprecedented times. The premium holiday was originally requested by the Society and endorsed by the fund’s Actuarial and Underwriting and Finance/Investment/Audit committees before it was approved by the Board. The premium holiday will be in effect from July 1, 2020 through June 30, 2021.

“COVID-19 has posed unprecedented health and economic challenges to our state, and the health care industry is no exception,” said Bud Chumbley, MD, MBA, a Fund Board member and the CEO of the Wisconsin Medical Society. “The premium holiday approved yesterday by the board will provide some financial relief to many of the Wisconsin medical professionals and providers who have been affected by the pandemic and who face ongoing challenges.”

This action will help those covered by the Fund who have experienced a significant decline in revenues due to the COVID-19 pandemic, particularly physicians in solo and small group practices.

The Fund is an essential element in maintaining medical liability insurance premiums at a manageable rate for those covered by the Fund. The favorable medical liability environment in Wisconsin helps recruit physicians to Wisconsin and retain physicians in Wisconsin.

Full-time physicians will save between $382 and $2,521, depending on their specialty, with Residents saving $229 and part-time or retired physicians saving $95.

As of June 30, 2019, there were a total of 17,261 fund participants composed of 147 hospitals with 19 affiliated nursing homes, 15,003 physicians, 855 nurse anesthetists, 20 hospital-owned or controlled entities, 73 ambulatory surgery centers, 1 cooperative, 14 partnerships, and 1,129 corporations actively participating in the Fund. As of June 30, 2019, Fund participants consisted of 87 percent physicians, 6 percent corporations, and the remaining 7 percent included all other participants.

Additional details can be found in the Society’s update or the Fund’s press release.