As you have probably heard, the ObamaCare website has had some serious glitches, but now there is a way to avoid all that. Medicoverage announced today that they are able to quickly submit paper applications for ACA Bronze, Silver, Gold, and Platinum plans in most states.
ObamaCare ACA Paper Application
The Affordable Care Act paper application is now available for individuals and families in the following states. This is the easiest way to apply for health coverage. Click on your state below to access the application.
You can call an agent to receive help while filling out the app or selecting the right plan by calling 800-930-7956. We are here to help you. Many people don’t realize that there is no fee to work with an agent. With our help and the new paper application you won’t experience the ObamaCare website timing out nor the long wait times for hotline assistance (apparently reported up to 45 mins!). And, not to worry, you will be still be eligible for ObamaCare subsidies if you qualify.
When you’re done with your application fax it to 310-765-4136 or mail it to the address on the cover sheet of your application.
Anthem BlueCard is back after a two year hiatus. This program allows anyone enrolled in an Anthem Blue Cross CA PPO, purchased on or off the Obamacare exchange, to use the BlueCard to see any doctor or facility in the nationwide Anthem network.
This may or not be available in your state, as well as, our contact at Anthem tells us it is not for HMO, POS, or EPO type plans. Click here to get an individual healthcare quote in your area, and call us to see if BlueCard is available for your Anthem health plan.
HSAs are here to stay. Health Savings Accounts are included in some of the new ObamaCare plans offered on and off the exchange.
HSAs (Health Savings Accounts) will be available to enrollees in markets where they are available. HSAs are high-deductible, tax advantaged health savings plans. Money contributed to an HSA is not subject to being taxed when deposited. With these plans the money in the savings account can be used to pay for medical services right away, and funds not used will roll over and accumulate. These plans generally have lower monthly premiums because of their high-deductible. Click here to get an individual HSA health plan quote.
Cedars-Sinai just announced that it is will join the Blue Shield of California network as of March 1, 2015.
Which Blue Shield Plans Cover Cedars?
All Blue Shield on and off-exchange PPO plans will cover Cedars-Sinai Medical Center, and have access to Cedars-Sinai Medical Group and Health Associates. Having “access” means that some doctors may choose not to work accept new patients or to take Blue Shield. You’ll want to confirm with your doctor before visiting to make sure they take your insurance.
Even if you enrolled through another plan during Obamacare Open Enrollment or chose to continue with your previous plan you are still able to change to Blue Shield or any other provider until February 15, 2015 for a March 1st effective date.
If you have any questions, please call the number above.
Anthem Blue Cross of California has extended its off-Exchange deadline until December 31, 2014 for a January 1st start date. There is one caveat, you must enroll through a paper application. If you try to enroll online, you will have a February 1, 2015 start date.
Who Should Use the Anthem Extension?
If you don’t qualify for premium subsidies and/or cost-sharing subsidies, and if Anthem’s network of doctors and hospitals works for you, then you may want to enroll in an Anthem plan.
Anthem Paper Application
If you have decided that an Anthem Blue Cross CA plan is right for you, you can NOT enroll through the online process for a January 1st start date. You MUST enroll through the Anthem paper application. Here are the steps you’ll take go enroll in a paper application:
1) Click here to get an off-Exchange quote (may have trouble accessing quotes in Chrome browser) 2) Choose an AnthemBronze, Silver, Gold, or Platinum plan3) Click on “Apply Now”4) Fill out the online portion on the screen5) Choose the paper application option6) Mail in your application (you can NOT fax it)
Next Steps
For help filling out your application or for help picking a plan please call the number above.
Covered California has extended its Obamacare exchange enrollment deadline to December 21st, for a January 1, 2015 start date.
What Covered Ca’s Extension Means for You
If you want Affordable Care Act (ACA) coverage beginning January 1st you can still enroll on the exchange in one of the Bronze, Silver, Gold, or Platinum plans. You can still qualify for premium subsidies and cost-sharing subsidies to help with your health costs. While the exchange plans have extended their deadline, many off-exchange plans have not.
When Does Open Enrollment End?
Even if you miss the December 21, 2014 deadline, you will still be able to enroll in a health plan in California until February 15, 2014.
Next Steps
If you’re ready to enroll in a health plan call the number above or click here to get an ACA application.
Cedars-Sinai accepts several Obamacare Exchange plans and off-Exchange plans to receive coverage from the world-renowned California hospital and its providers. UPDATED 11/13/2014
Obamacare Exchange Plans Accepted by Cedars
Obamacare Exchange plans are plans sold through your state’s website or through a certified agent and allow for Affordable Care Act subsidies. The following are Obamacare Exchange plans that offer full coverage benefits at Cedars-Sinai:
Off-Exchange plans are sold outside of your state’s website from a certified agent and don’t qualify you for income based subsidies to help with your premium and medical costs. Many people choose to enroll in these plans because the network is larger and you don’t have to share private information. The following are off-Exchange plans that offer full coverage at Cedars-Sinai:
Assurant Health offers a range of PPO plans**
Anthem Blue Cross PPO plans may offer coverage**
Anthem Blue Cross EPO all metal levels
**Check with your agent to learn which off-Exchange PPO plans are available for full coverage at Cedars.
Covered California announced as of today, August 4, 2014, all participants in the healthcare plans through the Exchange are required to prove their identity.
CA Identity Proofing
Covered California now requires that all applicants show proof of their identity. This can be done through an insurance agent or broker. Once you do it, you don’t have to show proof of identity again.
There are certain circumstances that qualify you for a CA Special Enrollment Period: divorce, adoption, graduated from college, loss of job-based insurance, and other circumstances. If you think you qualify call 800-930-7956 or click here to fill out a CA health plan application.
Covered California, California’s ObamaCare Exchange, announced that it has created a Special Enrollment Period for those covered by COBRA. Starting May 15, 2014 and running for 60 days, people who have coverage through COBRA can enroll in a Bronze, Silver, Gold, or Platinum plan.
Exchange Plans Could Save You Money
Most of the time an Exchange plan’s premium will be less expensive than a COBRA premium, as well as Exchange plans offer premium subsidies and cost-sharing subsidies that can significantly lower what you pay per month and your out of pocket costs, respectively.
In a statement from Covered California Executive Director Peter V. Lee, “For some people who have COBRA coverage, purchasing a plan in the Covered California marketplace during this special-enrollment period could save thousands of dollars a year.”
How to Enroll in an Exchange Plan
If you have Federal COBRA or Cal-COBRA you can enroll in one of the new Affordable Care Act plans until July 15, 2014.
For help enrolling through an agent (remember in CA and most states an agent doesn’t cost you anymore money than enrolling on your own) call the 800-930-7956 or fill out an application at HealthApplication.com.
All Affordable Care Act plans must be enrolled in by March 31, 2014 to avoid a penalty*. However, Covered California is concerned that there will be such an influx of last minute applications that it has made an exception for online applicants. Paper applications MUST be postmarked by March 31, 2014, however, Covered California stresses to avoid a penalty individuals should only use the online application at this point.
Covered CA announced yesterday, if an individual starts their ObamaCare application by March 31, 2014 they will be able to complete their application by April 15, 2014 to avoid the ACA penalty. This is to enroll in the Bronze, Silver, Gold, or Platinum ACA plans. The enrollee must do the following to qualify:
Create an online account.
Fill out all required information on the “Apply for Benefits” page and hit “Continue.”
After hitting “Continue,” individuals will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit.”
They must return to their online account no later than April 15 to complete the application and select a plan.
Covered California reminds consumers that they must make their first premium payment to the health insurance company by the due date to avoid the tax penalty.
California ObamaCare Help
To enroll in an ACA plan call 800-930-7956 to have an agent enroll you and answer your questions.
*Remember if you’re 65 or over and qualify for Medicare you don’t enroll in ObamaCare plans. Click here for Medicare help.
Covered California just announced that Californian’s who signed up for a CA ObamaCare plan with a January 1st start date now have until January 15, 2014 to pay for their premiums. The ACA plans are known as the Bronze, Silver, Gold, and Platinum plans.
CA Payment Extended: What About Coverage?
Don’t worry, if you are enrolled in a plan with a January 1, 2014 start date you can seek medical treatment or get prescription drugs before you make your monthly premium payment. Just know that you will have to pay out-of-pocket for all services but will be reimbursed by your insurance company (if it applies with your plan) after you make your premium payment.
Payment must be received by January 15, 2014, it cannot be in transit or post-marked on that date.
Need to Enroll in a Covered CA Plan
For February 1st coverage you will need to enroll by January 15, 2014. Go to HealthApplication.com to find a Covered Ca quote, application, and guidance.
Remember you make your payment directly to the insurance company. For further questions call 800-930-7956 or contact Medicoverage.
When looking at ObamaCare plans, a Catastrophic plan may be the most cost effective if you’re under 30. But not always. Let me explain.
Breaking Down the Catastrophic Plan
Basically in some states the Bronze plans and Catastrophic plans may have you pay similar out-of-pocket costs (within a few hundred dollars) before your insurance pays toward your healthcare, BUT the Catastrophic plan generally will cost less each month.
However, if you qualify for monthly premium subsidies your Bronze plan’s monthly cost could be less. As well as, in some states, including California, your Bronze plan insurance provider may start paying towards your medical care costs way before the Catastrophic plan would.
This may seem counter-intuitive, however if you qualify for cost-sharing subsidies ONLY the Silver plan offers tax credits to help reduce costs when you seek medical care. At that point, the Silver plan may be the right choice for you.
Conclusion
Just because something looks less expensive, like the Catastrophic plan, it may not be. Remember to choose a plan based off your medical needs, budget, and network of doctors and hospitals. For further questions about plans call 800-930-7956 or contact Medicoverage.
Covered California’s ACA SHOP* plans are still not functioning properly, even though an email sent out today claimed they were. The enrollment and quote tool for small business is down. However, small businesses have another option than using the websites: ACA paper enrollment through agents is available for all individuals, families, and small businesses. Small businesses will still be eligible if they apply through an agent for ACA business tax credits if they are eligible.
*SHOP stands for small business health option.
When I spoke with our contact at Covered Ca, they said it would take some time for that tool to be function as it is supposed to. This comes on the heels of CMS’ announcement last week that the federally run SHOP exchanges will not be launched until April, leaving agents the only option for enrollment in over 30 states.
To make sure you and your employees are enrolled by January 1, 2014 in a new Affordable Care Act plan call 800-930-7956 or contact Medicoverage.
The federally run Obamacare plans have received an extension till December 23, 2013 for a January 1, 2014 start date. This gives consumers in those states an extra 8 days to decide on one of the new Bronze, Silver, Gold, or Platinum plans.
ACA Applications
Go to Healthapplication.com to get your paper application. Once you fill out the application and send it in, you will be contacted to discuss plans and informed if you qualify for subsidies. Remember to fax, scan and email, or snail mail your application in as soon as possible.
To learn if your state has extended its deadline call 800-930-7956 or contact Medicoverage.
California’s health insurance marketplace board voted unanimously not to extend health insurance plans that are not ACA compliant. The state rejected President Obama’s offer of extending over 1 million California health plans that have been cancelled. The board chose to only enroll CA residents into plans that are Obamacare compliant by including the essential health benefits.
Due to the state’s ruling, California has extended its enrollment date by 8 days to Dec 23, 2013 for a January 1, 2014 start date. It also has extended the deadline for the first payment till January 5, 2014.
CA Grandfathered Plans Still Okay
If you enrolled in a plan prior to March 23, 2010, not to worry you can keep your current plan -the ruling by the exchange board does not affect your plan in any way. However, if you are eligible for federal subsidies they would not apply to your grandfathered plan.
To learn about plans available in California call 800-930-7956 or contact Medicoverage.
Anthem Blue Cross is the only provider offering ACA exchange plan coverage to UCLA Medical Center and other UC research hospitals, according to the LA Times. The ObamaCare plans known as Bronze, Silver, Gold, and Platinum have limited networks.
Make sure that you check your plans network of doctors and hospitals before signing up for the new plans. Call 800-930-7956 or contact Medicoverage to learn about the new plans.
Cedar-Sinai is only offered on two lower priced Health Net plans in the California ObamaCare exchange, according to the LA Times. It was previously thought that none of the California Bronze, Silver, Gold, or Platinum plans would include the world-renowned hospital.
Make sure to check a plan’s network before signing up. For questions about the new plans call 800-930-7956 or contact Medicoverage.
Covered California just announced their site will shut down enrollment from November 22nd to November 25th. Medicoverage has you covered during this time. Agents will be able to help with questions and enrolling in the new ACA Bronze, Silver, Gold, and Platinum plans.
Agents Can Help During Covered Ca’s Enrollment Blackout
Covered Ca says that although the enrollment part of the site will be down, Californians will still be able to browse the site for other information.
Get Your California ACA Application Here
Federal tax credits are available if you qualify, no matter if you go directly through the site or purchase from an agent. It is important to remember that an agent doesn’t cost anymore than purchasing directly from a provider or from Covered Ca.
While you are applying call 800-930-7956 or contact Medicoverage to answer any of your questions. After filling out the application, fax or mail it to contact info on the cover page.
We will do some more research and update this information as it comes in. Call 800-930-7956 or contact Medicoverage for the most up to date information for your state.
According to Covered California’s press release today, approximately 2.6 million people are eligible for federal subsidies to help with the new Affordable Care Act plans, known as the Bronze, Silver, Gold, and Platinum plans. As well as, more than 1 million additional Californians are newly eligible to receive no-cost or low-cost Medi-Cal.
Covered California’s Executive Director Peter V. Lee is optimistic that Alameda Alliance will be back on the Obamacare exchange in the future. Lee said, “Alameda Alliance has a solid provider network and is a valuable asset to the community.We look forward to the company getting its commercial license, so we can welcome its plans back to the exchange.”
Covered California learned that the company was not approved to sell commercial insurance plans through the Department of Managed Health Care. However, Alameda Alliance will continue to provide Medi-Cal to the California’s residents.
Call 800-930-7956 or contact Medicoverage to learn of other provider available in your area.
In the past fourteen days the Health Insurance Marketplace has been up and running there have been a lot of glitches. One of the big problems is many of the Exchange do not include networks of doctors and hospitals. How does someone choose a health insurance plan without all the details? We say, wait. Let us explain.
ObamaCare Exchange Problems
The following are a few of the problems that have occurred in the past 14 days:
Doctors and hospitals not included in lists for consumers in some states.
California’s Doctor Finder Removed
The doctor and hospital finder on Covered California’s website went up a week after enrollment began, and was almost immediately taken down. We know that CA residents will find a smaller network, however consumers were finding that hospitals were not available within 100 miles, because Covered Ca had not updated all the networks not because they wouldn’t be available, according to San Jose Mercury News.
Senior and the ACA
Officials are concerned that seniors might become targets of ObamaCare scammers. So we are stressing to our clients: seniors who are on Medicare do not sign up for ACA plans. If you are over 65 and do not qualify you can sign up for the new ACA plans. This message is extremely important as there is a lot of confusion with the federal and state sites not fully up-to-date.
UPDATE 11/27/13: there is an easy way to fill out your Affordable Care Act application. First you go to Healthapplication.com and fill out the application send it in, and an agent will contact you about plans in your area, answer questions about doctors and hospitals, and tell you if you qualify for subsidies.
The Affordable Care Act has touted the 4 types of plans it is offering, however on a health plan reconnaissance mission of Covered California’s website those with a low income only have the choice of the Bronze plan or the Enhanced Silver Plan. Just because there are less options doesn’t mean it’s a bad thing as well as you’ll probably pay less when you seek medical care. Let us explain.
Less Choices for CA Low-Income Residents
The new Affordable Care Act metal plans: Bronze, Silver, Gold, or Platinum are available in all markets beginning January 1, 2013 (however remember the sign-up begins October 1, 2013). We haven’t found it written anywhere if you of low-income and seeking a subsidy that Gold and Silver plans would be unavailable, yet on CoveredCa’s individual and family rate page the only options for those with a lower income ($22,980 or less per year) are limited to the Bronze and Enhanced Silver Plan.
1) Bronze Health Plan
The Bronze plan generally has the lowest premium of all plans, however it can cost quite a bit more if you seek medical care. Bronze plan details for those who make $22,980 with premium subsidies are:
Deductible: $5,000
Out-of-Pocket Max: $6,350
Premium: As low as $63 a month
2) Enhanced Silver Health Plan
The Enhanced Silver plan is only one that includes cost-sharing subsidies for help with deductibles, coinsurance and copays. With subsidies this plan can go from the traditional coverage of 70% to 94%. This is the reason lower income people don’t have the option on the Exchange of a Gold plan or Platinum plan, due to the possibility that Silver’s out-of-pocket costs could be less for those who qualify and have a significantly lower premium.
Enhanced Silver plan details for those who make $22,980 with premium and cost-sharing subsidies are:
Deductible: $500
Out-of-Pocket Max: $2,250
Premium: As low as $105 a month
Which Plan Should I Choose?
Up to what you can afford, but if you can spend $40 more a month the Silver plan is a much better deal.
Do I Have to Buy Insurance?
Almost all Americans are mandated to have insurance as of January 1, 2014. So, more than likely yes. There are, of course, exemptions to the ACA mandate. When you purchase if you think you qualify for subsidies you’ll probably want to purchase a Health Insurance Marketplace plan. However, if you know you don’t qualify you have the option to purchase either on or off-Exchange plans. Remember there are plans outside of the exchange that may work better for you. Your newly established state’s call center’s navigators or insurance agent can help you figure out which plan is right for you.
Cedars-Sinai is a world-renowned hospital in Los Angeles, however none of the new Affordable Care Act plans in California have the hospital in-network. The new metal plans are known as the ObamaCare Bronze, Silver, Gold, and Platinum Health Plans.
Why is ObamaCare leaving a world class hospital out? Well, it’s not ObamaCare it’s the insurance companies who are trying to keep costs down. Cedars-Sinai is one of the most expensive hospitals in the world, and by limiting networks in California insurers are able to keep premiums lower. Even though Health Net is attempting to bring in Cedars in its Los Angeles region plans, the insurance company has stated that the new metal plan policyholders will be limited to 36% of their non-ObamaCare plan members.
Advocacy groups are concerned the limited networks will stop patients from getting appropriate care. California has stressed that 80% of hospitals and physicians are still covered under the new plans, however each insurer’s plan is still in a tight network. Grandfathered plans (plans enrolled in before March 23, 2010) are exempt from these limitations. Also plans purchased outside of the Health Insurance Marketplace may be exempt. There are plans available now that have a policy end date of December 31, 2014, which may include Cedars as one of their hospital options.
UPDATE: Cedars is included in 2 lower priced Health Net plans. 11/15/13
To learn about plans available now or the new metal plans call 800-930-7956 or contact Medicoverage.
The Affordable Care Act plans offer new benefits with its new “metal” plans, however in California choices of doctors and hospitals are being limited by insurers. Insurance premiums came in lower than expected and one of the reasons is keeping most California’s metal plans within networks. The new plans are known as the ObamaCare Bronze, Silver, Gold, and Platinum Health Plans.
According to the L.A. Times, Health Net’s, “exchange customers will be restricted to 36% of its regular physician network statewide.” But it isn’t just Health Net. Some hospitals are only in one network, like UCLA’s Medical Center is only covered by Anthem Blue Cross. The world-renowned hospital Cedars-Sinai may not be assigned to any insurer’s metal plan. Californians need to check to see if their doctor and hospital are in network with the plan they choose.
There have been concerns expressed that insurance providers may not be offering viable options for many patients. However according to the L.A. Times, “State officials sought to blunt that criticism this week, pointing out that the 13 health insurers selected will offer access to about 80% of California’s practicing physicians and hospitals.”
One reason insurers are limiting networks is because of the new ObamaCare essential health benefits that must be covered such as ambulatory services, emergency care, pediatric dental, and mental health. Adding these benefits are to help patients but cost more to insurance companies.
This narrow network plan layout is not exclusively in California. There are plans available now that policies end December 31, 2014, and these plans do not have the same restrictions as the metal plans. To learn about plans available now or about coverage with the new metal plans call 800-930-7956 or contact Medicoverage.
California’s Silver plan offers a lot of benefits before the deductible is met. The individual mandate begins on January 1, 2014, with enrollment running from October 1, 2013 to March 31, 2014.
CA Silver Plan Details
The Silver plan is considered the standard of the plans, as it offers coverage before the deductible is satisfied, unlike the California ObamaCare Bronze plan. This plan has a 70/30 split, with the insurance company covering 70% of your services before you meet your out-of-pocket max.
Benefits
Silver Health Plan*
Deductible
$2,000 Med
Preventive
$0
Doctor’s Office Visits
$45
Specialist
$65
Generic Rx
$25 or less
Brand RX
$50 *after $500 Rx deduct
Lab Testing
$45
X-ray
$65
ER Visit
$250 *after deduct
Urgent Care
$90
Out-of-Pocket Max
$6,350/$12,700 (ind/fam)
CA Silver Plan Premiums
The average Silver premium for a 40 year old, non-smoker is $294. However this does not include ObamaCare federal premium subsidies, which can make the monthly premium drop to $58. Remember premiums are based off age and area. For your specific premium call 800-930-7956.
Difference Between Silver and the Other Metal Plans
As stated above, Silver is considered the standard plan. If a provider offers any plans they must offer the Silver and Gold plans. Silver is also the only plan that offers ObamaCare cost-sharing subsidies to individuals and families making less than 250% of the poverty line: $28,725 for an individual and $58,875 for a family of four.
California released its Platinum plan premiums and details. Platinum is the Cadillac of plans which has the lowest out-of-pocket maximum of all the new metal plans and your provider covers 90% of your medical costs before you hit that that max. All metal plans much include the ObamaCare 10 essential health benefits and providers must abide by the 80/20 Affordable Care Act Rule, where providers must spend 80% of the plan’s policyholders’ premiums on health care or refund their policyholders.
CA Platinum Plan Breakdown
The California Platinum Plan features no deductible, so policyholders have first-dollar advantage. Below is a chart of Covered California’s Platinum plan (plans may vary by provider):
Benefits
Platinum Health Plan*
Deductible
$0
Preventive
$0
Doctor’s Office Visits
$20
Specialist
$40
Generic Rx
$5 or less
Brand RX
$15
Lab Testing
$25
X-ray
$40
ER Visit
$150
Urgent Care
$40
Out-of-Pocket Max
$4,000/$8,000 (ind/fam)
CA Platinum Plan Premiums
Platinum premiums are the highest per month, with a range of $285 to $687 for a 40 year old. However this does not include ObamaCare federal premium subsidies, which can drop the premium significantly. Remember premiums are based off age, area, and provider. For your specific premium call 800-930-7956.
How Platinum Differs From Other Metal Plans
With the proposed no deductible, and highest monthly premium, Platinum plans are expected to attract the sickest Californians. This could in turn raise premiums drastically in coming years. Even though it has a higher monthly premium, Platinum members will be able to foresee costs because they have a lower out-of-pocket max, and they only pay 10% of their medical costs until then. \ Click here to compare the ObamaCare Bronze plan, Silver plan, Gold plan, and Platinum plan side-by-side.
California has released its preliminary Gold plan premium and plan breakdowns. All Gold plans much include the ObamaCare 10 essential health benefits, providers must cover 80% of your medical costs before you hit your out-of-pocket max, and providers must abide by the 80/20 Affordable Care Act Rule, where providers must spend 80% of the plan premiums on health care or refund their policyholders.
CA Gold Plan Overview
The California Gold plan offers many benefits before the policyholder satisfies the deductible, unlike the California ObamaCare Bronze plan. Below is a chart of how an average Gold Plan breaks down.
Benefits
Gold Health Plan*
Deductible
$0
Preventive
$0
Doctor’s Office Visits
$30
Specialist
$50
Generic Rx
$25 or less
Brand RX
$50
Lab Testing
$35
X-ray
$50
ER Visit
$250
Urgent Care
$60
Out-of-Pocket Max
$6,350/$12,700 (ind/fam)
CA Gold Plan Premiums
The average Gold premium for a 40 year old, non-smoker range from about $370 to $600 per month. However this does not include ObamaCare federal premium subsidies, which can drop the premium significantly. Remember premiums are based off age, area, and provider. For your specific premium call 800-930-7956.
The Gold Plan in Comparison to Other Metal Plans
The Gold plan has second highest monthly premium, with “first-dollar” advantage. That just means that as soon as you seek health care your provider will start paying toward your medical bills. A plan like the Bronze plan may have a lower monthly premium, but a Gold plan, if you get sick, could save you money throughout the year. Click here to compare the ObamaCare Bronze plan, Silver plan, Gold plan, and Platinum plan side-by-side.
Beginning January 1, 2014 all individuals are mandated to have health insurance. The plan with the lowest monthly premium is the Bronze Plan*, with the highest deductible. California was the first to release its premiums and rates. It important to remember that all new health plans must include the ObamaCare essential health benefits, however each state and/or provider may offer additional or extended benefits.
*Some job-based plans may actually offer lower Silver plan premiums than Bronze.
ObamaCare includes three new benefits previously unavailable or with a copay. These new benefits include certain over the counter drugs at no cost, free breast cancer genetic counseling and testing, and in California, transgender services with the new ObamaCare plans: ObamaCare Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan.
ObamaCare Over the Counter Drugs
Certain over the counter drugs will be covered at a $0 copay for preventive purposes when prescribed by a doctor, such as:
Aspirin to reduce heart attack
Oral Fluoride for children to prevent tooth decay
Folic Acid for women to help prevent birth defects
Iron supplements for children to prevent anemia
Female contraceptives: such as the morning after pill*
*The morning after pill being offered at no cost is a controversial subject because people are saying that it isn’t preventive care. However, others are saying it is considered preventive in case of incest, rape, other form of birth control failing.
Also, birth control prescribed by a doctor should be covered at a $0 copay for women in all states.
ObamaCare Breast Cancer Genetic Counseling and Testing
For women who are eligible under U.S. Preventive Services Task Force guidelines will receive, for a $0 copay, in-depth genetic counseling to assess the risk of carrying a breast cancer mutation, as well as for high-risk persons testing will be covered when ordered by a physician.
ObamaCare CA Transgender Services Will be Covered
In California all job-based plans must cover cost-sharing for transgender services such as:
Cost-sharing reassignment surgery
Mastectomy with chest reconstruction
Mental Health
Hormone therapy
Seniors $0 Preventive Care
First off it’s important to note that seniors do not need to do anything in regards to the Affordable Care Act -seniors will still be enrolled with Medicare. The new benefits available to Medicare recipients is the ACA offers $0 preventive care for seniors, such as wellness visits, mammograms, and colonoscopies.
For further questions about how this will affect your coverage call 800-930-7956 or contact Medicoverage.
UPDATE 8/7/13: Ventura County Health Care Plan has opted out of the Heath Insurance Marketplace in California. Plans available in Ventura are Anthem Blue Cross of California, Blue Shield of California, and Kaiser Permanente of California. For those who choose to enroll in either Anthem Blue Cross or Blue Shield will have access to care at Ventura County Medical Center, Santa Paula Hospital, as well as over 30 medical clinics.
Ventura County Health Care Plan announced on May 23, 2013 that it will offer new California Healthcare Exchange plans beginning January 1, 2014. They were selected as one of 13 providers by Covered California to offer Exchange plans. As a community-focused, County-sponsored Health Maintenance Organization, the Ventura County Health Care Plan (VCHCP), has 20 years of experience building a provider network specifically designed to serve Ventura County residents.
“VCHCP is focused on serving the needs of Ventura County Residents newly eligible for insurance coverage as a result of health care reform and we believe our participation in Covered California will provide the best solution for our shared community,” stated a VCHCP spokesperson.
Region
Region 12: San Luis Obispo, Ventura, Santa Barbara
Network
Hospitals: 6
Physicians: 176
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Kaiser Permanente of California just announced its rate increase for grandfathered plans in 2014 to be 7.1%. This unusual and early announcement was released to better help policyholders decide if they want to keep their plan or switch from their plan to one of the new ObamaCare metal plans known as the Bronze plan, Silver plan, Gold plan, and Platinum Plan.
A grandfathered plan is one in which the person was enrolled in prior to March 23, 2010. If you are unsure if you have a grandfathered plan call 800-930-7956 or contact Medicoverage.
Covered California just released its updated ObamaCare rates for small businesses to use the Small Business Health Option Program (SHOP). SHOP is dedicated to employers with 50 or less employees (beginning in 2015 employers with up to 100 employees may use the program). Small businesses (under 50) are not mandated to offer insurance by the Affordable Care Act, however to make small businesses more competitive with large group plans, ObamaCare is offering a program with affordable group care. Businesses with 50 or more full-time equivalent employees are mandated to offer insurance to their employees starting in 2015.
California’s SHOP, which begins January 2014, includes six insurance providers for 19 regions. Employers choose an “anchor” plan from one of the metallic levels known as the Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan, then employees can choose the anchor plan or a plan that is lower, at no extra cost to the employee. If an employee chooses a plan with a higher level of coverage, the employee will pay any extra costs associated with the more expensive plan.
The average rate for the three lowest Silver Plan monthly premiums for a 40 year old employee is $346 (averaged from 6 regions). According to Covered CA, this brings the average cost down in these six regions by 11.5% compared to small group rates in 2013, with San Francisco County seeing the greatest drop at 28%.
Employers with less than 25 employees and offer health insurance may receive a tax credit to help cover the cost of their employees’ premiums. To learn if you qualify for a subsidy or about CA small group plans call 800-930-7956 or contact Medicoverage.com.
Beginning October 1, 2013 the Exchanges open to enroll in the new metal plans, known as the Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan. The concern that many state commissioners have is so many new “navigators” are hired to help people get insurance, allowing them access to enrollees’ personal information such as health records, tax forms, and social security numbers. Because there will be so many new hires, 21,000 in California alone, the question is will they be vetted properly.
With the enrollment of an expected 2 million new uninsured CA residents, the navigators will have a lot of information in their hands. According to CNBC, California Insurance Commissioner Dave Jones stressed his concerns, “We’ve been urging our benefits exchange to make sure there are comprehensive enough consumer protections in place, to make sure that fraudsters don’t get into this market,” said California Insurance Commissioner Dave Jones.
Commissioner Jones went on to say, “We’ve convinced Covered California, our health benefits exchange, to adopt a system of fingerprinting background checks, some minimal training and certification,” said Jones, “but we believe they should go further.“Commissioner Jones wants Covered California to oversee the navigator program and have penalties set in place for the occasion of fraud.
Eva Velasquez, CEO of the Identity Theft Resource Center,is concerned with how the states are setting up the exchanges. One of her biggest concerns is already present, “We’ve already noticed in paid searches there are websites coming up that have nothing to do with Obamacare.”
Many people are unaware that they are able to work with trusted agents and brokers in the Exchange. There is so much information out there, and so little is clear to Americans, that most people think they can only purchase through the states’ or federally set up sites. Working with agents who have done this for years, like Medicoverage.com, will be able to help safeguard information, as well as having an online presence where consumers can check their business practices. It is important to know that insurance premiums are never higher with an agent than they are when purchased directly through a company or through the Exchange.
For further questions about the Exchange call 800-930-7956 or contact Medicoverage.
Covered California Executive Director Peter V. Lee explained why releasing these providers and plans is so important: “These plans dovetail with our mission to make sure every person in the state — and particularly our youngest and most vulnerable — get improved health care.”
Obtaining Dental Insurance
Good news, you don’t have to wait until the Health Insurance Marketplace goes fully in effect January 2014, because all current dental plans accept members without regard to preexisting conditions and run month to month. If you need assistance changing or obtaining dental care call 800-930-7956 or contact Medicoverage.
California has opted to have dental as a stand-alone plan for children for the new ObamaCare Health Exchange Plans. California was the first state to release its plans and premiums, and now it is leading all the other states in making its pediatric dental Exchange plans transparent.
CA pediatric dental premiums released 6/25/13. These premiums range from less than $10 a month to about $30. The pediatric dental premiums range in price by area and plan. There two types of plans offered are one with an actuarial value of 85%, and one with an actuarial value of 70%. All those values mean is you would pay 15% or 30%, respectively.
Pediatric dental, although an essential health benefit, does not need to purchased for children according to Covered California Executive Director Peter V. Lee “Purchase of the pediatric dental benefit is not required. However, the plans offer comprehensive child dental coverage, particularly important for consumers of child-only coverage and family plans.” Although Lee went on to talk about the importance of children having access to dental care: “Dental care is a vital component of overall health, and especially critical for our state’s children. Access to dental services as a youngster means better health, both for children and as they get older.”
Under ObamaCare a stand-alone dental plan meets the requirements, however Lee’s statement that having pediatric dental benefits is not a requirement is in conflict with the Affordable Care Act’s list of essential health benefits. Hmmm.. We will continue to look into this as more states release their dental care plans and update this page accordingly.
Adults Dental Care and ObamaCare
Because all of this is so new there isn’t a lot of concrete info about how adult dental plans will work once the Exchange kicks in. The Essential Health Benefits aspect of the Affordable Care Act only addresses pediatric dental not adult dental. To learn more read the article New ObamaCare Health Plans Do Not Include Dental and Vision.
Should I Wait for the Exchange to get Dental Coverage?
No. And there are two reasons why you wouldn’t want to wait.
1) As of now all dental coverage has guaranteed issuance, which just means that anyone who applied for dental, gets dental. 2) Dental plans are month to month, so better to get coverage now if you have an emergency root canal or need your wisdom teeth out.
Ready to sign up for dental coverage
For further questions about dental coverage in your state call 800-930-7956 or contact Medicoverage for assistance.
Aetna the 4th largest insurance provider in California is bowing out of the individual Health Insurance Marketplace. Aetna will stop taking applications for individuals as of July 15, 2013. And it is expected that about 50,000 individual policyholders will have to find new coverage in California. Aetna will continue to offer group insurance, dental, life, and Medicare.
California Insurance Commissioner Dave Jones is disheartened by Aetna’s choice to leave the market, “A competitive market with more choices for consumers is important as we implement the Affordable Care Act.” He stressed that Aetna leaving was not good for the Health Insurance Marketplace in California.
Aetna was not a plan chosen to work with the Exchange, but it was expected that they would continue to offer grandfathered plans after January 2014 -which is not happening.
Anthem Blue Cross, Kaiser Permanente, Molina, and 10 other insurance providers will participate in the new “metal” plans called the Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan.
The Affordable Care Act helps the uninsured in a few ways. For instance, in the LA Times today there was an article about a woman making $12.68 an hour, mother of one child, lives in Los Angeles, and recently choose to forego surgery because she was uninsured. As of January 1st this woman would have options for health coverage.
How the Affordable Care Act Helps Uninsured
She isn’t qualified for Medicaid, however since she works she may qualify for job-based insurance as 2015. Until then and if her employer doesn’t offer insurance she would qualify for premium subsidies and cost-sharing subsidies, and her daughter would qualify for Medi-Cal.
Costs for Lower-Income Families
The article doesn’t state how old she is, but if she is 30, her Silver plan premium could be as low as $93 a month and her deductible would be reduced from $2000 to $500, and a reduced maximum out of pocket from $6,350 to $2,250. This would apply to any single parent to one child living in the Los Angeles area, making her salary.
How do Lower-Income Families and Individuals Get Insurance?
First, it’s important to remember for anyone purchasing a plan from the Health Insurance Marketplace you need your W2 paperwork and financial information handy like child support, alimony, assets. Then you can either go directly through your state’s newly established call center’s navigators or you can go through your insurance agent. Many don’t realize that agents can help with on and off-Exchange plans.
Lower Income Seniors
Seniors do not have to do anything as of January 1st. Seniors stay on Medicare and do not apply for the new metal plans. Make sure your friends and parents are aware that there is nothing for them to do, because states are vocally expressing their concerns about seniors being tricked by scammers into giving away personal information due to the lack of awareness in regards to the ACA.
To learn if you qualify for a subsidy call 800-930-7956 or contact Medicoverage.
California Has Released its Average Monthly Premiums for Bronze and Silver Plans
The chart below demonstrates the average monthly premium in California. CA plans are based on plan, region, and provider, to learn your specific monthly premium for your area or for Gold or Platinum premiums, call 800-930-7956.
*The figures are above are for individuals. Remember these numbers are averages and not your specific premium, click here to get your specific Exchange Premium.
Important Silver Facts
Although the monthly premium might be somewhat higher than Bronze, remember with Silver you pay 30% of your medical costs, Bronze 40%. As well as if you fall below 250% of the Federal Poverty Line (FPL) -under $28,725, and have a Silver plan, you may qualify for Federal Cost-Sharing Subsidies. Weigh both before you decide on your plan.
Next Steps
For specific premium information for your CA region or state please contact Medicoverage.
Catastrophic Coverage is available for those under 30 years of age and do not qualify for tax credits. These plans do not offer the essential benefits before you meet your out-of-pocket max, but are designed to protect you in case of emergency. Essential benefits are required of the metal plans immediately. These new plans are called: Bronze, Silver, Gold, and Platinum. Click here to learn if you qualify for catastrophic coverage.
Catastrophic Plan 21 Year Old
$0 -$45,960 Income
Most Affordable
$136
2nd Most Affordable
$153
3rd Most Affordable
$168
***The above figures are based off of California’s recently released statewide overview of average monthly premium costs for a 21 year old. The above are averages, contact 800-930-7956 for your specific premium.
Further Questions:
For any other questions about your state’s specific Catastrophic Plans premiums or for “metal” plan premiums Contact Medicoverage.
It was announced today that Alameda Alliance for Health has been selected by California among 13 providers to offer coverage with the new Healthcare Exchange beginning January 2014. This public, not-for-profit managed care health plan has been in business for over 16 years. The insurer offers multilingual services, free health education programs, case management and disease management programs for members.
Region
Region 6: Alameda
Network
Hospitals: 12
Physicians: 3,100
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Health Net will offer new California Healthcare Exchange plans beginning January 1, 2014; one of 13 providers selected in California. Health Net helped pioneer the affordable and effective HMO model in California for employer- sponsored coverage, and they will continue to extend their value-based tailored network products to individuals.
Region
Region 2: Napa, Sonoma, Solano, Marin
Region 4: San Francisco
Region 5: Contra Costa
Region 7: Santa Clara
Region 8: San Mateo
Region 9: Santa Cruz, Monterey, San Benito
Region 10: San Joaquin, Stanislaus, Merced, Mariposa, Tulare
Region 14: Kern
Region 15: LA north
Region 16: LA south
Region 17: San Bernardino, Riverside
Region 18: Orange
Region 19: San Diego
Network
Hospitals: 204
Physicians: 44,000
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Sharp Health Plan, announced today by Covered California, will offer new California Healthcare Exchange plans beginning January 1, 2014. They are among 13 selected providers. Sharp Health Plan is San Diego’s only locally based commercial health plan, this not-for-profit delivery system was formed in 1979.
“This partnership with Covered California gives us the opportunity to expand our role in improving access to affordable, high- quality health care coverage for San Diegans,” stated by a Sharp Health Plan spokesperson
Region
Region 19: San Diego
Network
Hospitals: 7
Physicians: 2,600
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Contra Costa Health Plan will offer new Healthcare Exchange plans beginning January 2014. They have been selected among 12 other providers in California. Contra Costa Health Plan is the first county-sponsored health plan in the nation to receive federal qualification and to offer Medicare, the plan began enrollment of Medi-Cal patients in 1973, becoming a model for managed care health plans nationwide. Today, the plan delivers services to county employees, small and large business groups, seniors, people with disabilities, children and low- income patients.
“CCHP is pleased to continue to be a part of the health care solution, in the past, in the present and in the future,” quote from Contra Costa Health Plan spokesperson.
Region
Region 5: Contra Costa
Network
Hospitals: 10
Physicians: 5,000
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Molina Healthcare Inc. just announced that it will offer the new metal California Healthcare Exchange plans beginning January 1, 2014. They were chosen among 12 other providers in California to offer Healthcare Exchange plans. Molina Healthcare began as a single clinic providing care for low income individuals. Now 33 years later, Molina has grown into a national managed care organization.
“Molina Healthcare was built on the idea of providing access to quality healthcare for all. As such, we are proud to be a partner with Covered California to do just that for the 5.3 million uninsured Californians who will now have access to health insurance,” stated a Molina Healthcare Inc. spokesperson.
Region
Region 3: Sacramento, Placer, El Dorado, Yolo
Region 15: LA north
Region 16: LA south
Region 17: San Bernardino, Riverside
Region 19: San Diego
Network
Hospitals: 29
Physicians: 4,568
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Western Health Advantage just announced it will provide new California Healthcare Exchange plans beginning January 2014. Covered California selected them among 13 providers to offer Exchange plans. Western Health Advantage is a not-for-profit health plan founded by UC Davis Health System, Dignity Health, and North Bay Healthcare System. Western Health Advantage (WHA) offers services to Northern California individuals, families, and employees through a network of regional health systems and medical groups.
“We want to improve the health and well-being of our neighbors by expanding access to healthcare, which is why Western Health Advantage is so very proud and pleased to partner with Covered California to achieve their mission of assuring access to high-quality health coverage for individuals in California,” stated a WHA spokesperson.
Region
Region 2: Napa, Sonoma, Solano, Marin
Region 3: Sacramento, Placer, El Dorado, Yolo
Network
Hospitals: 6
Physicians: 176
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
L.A. Care Health Plan announced today that it will offer new California Healthcare Exchange plans beginning January 1, 2014. They were selected as one of 13 providers in California to offer Exchange plans. L.A. Care, founded 15 years ago, is the nation’s largest publicly operated health plan. It is an independent local public agency created by the state and Los Angeles County to serve especially vulnerable and low-income populations.
“L.A. Care is proud to be part of Covered California, and looks forward to expanding our services to Los Angeles County residents,” stated a L.A. Care Health Plan spokesperson.
Region
Region 15: LA north
Region 16: LA south
Network
Hospitals: 35
Physicians: 1,005
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Chinese Community Health Plan has been selected among 12 other providers to offer new Healthcare Exchange plans beginning January 2014. Chinese Community Health Plan (CCHP) was formed in 1986 as an alternative HMO for patients served by the Chinese Hospital Health System. The Health System was created more than a century ago to serve Chinese-Americans who were often excluded from mainstream healthcare.
“We are delighted for the opportunity to partner with Covered California in meeting the needs of under served individuals,” quote from CCHP spokesperson.
Region
Region 4: San Francisco
Region 8: San Mateo
Network
Hospitals: 9
Physicians: 315
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Valley Health Plan will offer new “metal” California Healthcare Exchange plans beginning January 2014. They were selected among 13 providers by Covered California to offer Exchange plans. Valley Health Plan (VHP), licensed in 1985, a county-owned Commercial Health Plan, is a health plan option for individuals living or working, and small businesses located, within Santa Clara County.
“We want to improve the health and well-being of our neighbors by expanding access to healthcare, which is why Western Health Advantage is so very proud and pleased to partner with Covered California to achieve their mission of assuring access to high-quality health coverage for individuals in California,” stated a WHA spokesperson.
Region
Region 7: Santa Clara
Network
Hospitals: 4
Physicians: 993
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Covered California announced today that Blue Shield of California has been selected by California among 12 other providers to offer coverage to Californians with the new Healthcare Exchange beginning January 1, 2014. Blue Shield of California is a not for profit healthcare provider.
“Our mission is to ensure all Californians have quality health care at an affordable price,” quote from Blue Shield of California spokesperson.
Region
All
Network
Hospitals: 834
Physicians: 114,000
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Kaiser Permanente, California’s largest not-for-profit integrated health care delivery system, will supply new California Healthcare Exchange plans beginning January 1, 2014; one of 13 providers selected in California. Kaiser Permanente evolved from industrial health care programs for construction, shipyard, and steel mill workers during the late 1930s and 1940s. It was opened to public enrollment in October 1945. Today, Kaiser Permanente is one of the nation’s largest not-for-profit health plans.
“Since our founding in 1945, our mission is to provide high-quality, affordable health care and to improve the health of our members and the communities we serve,” Kaiser Permanente spokesperson.
Region
All EXCEPT for
Region 9: Santa Cruz, Monterey, San Benito
Network
Hospitals: 35
Physicians: 14,219
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Anthem Blue Cross of California, the largest provider in California, has been selected among 13 providers to offer coverage with the new Healthcare Exchange beginning January 2014. Anthem Blue Cross has partnered with a range of providers including AltaMed, a health system with a long history of delivering quality care to under served Southern California communities; the University of California Health, whose academic medical centers provide cutting-edge specialized care along with research and education; and an extensive network of Accountable Care Organizations to help Anthem Blue Cross join the Exchange in improving the health of all Californians by assuring access to affordable and high quality care.
“We realize our state’s health system will change over the next few years, and Anthem is committed to working with Covered California to improve health care quality, lower costs and reduce health disparities,” statement by Anthem Blue Cross of California.
Region
All
Network
Hospitals: 300
Physicians: 30,000
Further Questions:
If you want to learn more about Healthcare Exchange plans in your region call 800-930-7956 or contact Medicoverage.
Are you ready for the new California Health Care Exchange? We have put together a quick list the most important things you must know before Obama Care kicks in.
1) On January 1, 2014 everyone in the Golden State without insurance will have to purchase federally approved health insurance. Those without coverage will have to pay a penalty. To learn more about penalties and who is exempt please read the article Affordable Care Act: Penalties for the Uninsured.
2) Open enrollment for the new plans starts October 1, 2013 through March 31, 2014.
3) Everyone will be approved for health insurance in California even if they have a preexisting condition or have never been covered before. To learn more about coverage for everyone read the article ObamaCare: Guaranteed Issuance for Everyone.
5) You don’t have to figure this out on your own. Please contact us at 800-930-7956 or at Medicoverage: CA Health Exchange and we will help you understand the plans and see if you qualify for subsidies.
In 2010 most health insurance companies in California ceased offering plans to individuals under 19 after last year’s federal health care guaranteed issuance law went into effect. Under the law, insurance companies were forced to accept anyone younger than 19, regardless of their health history. The insurance companies response was to stop selling any plans to individuals under 19 rather than comply with the law. This created negative feedback the White House and other patient rights groups, who accused the health insurance companies of caring more about profits than the 80,000 under 19 children with no health coverage.
The insurance companies argued that the law unfairly punished them. They claimed there would be adverse selection as parents would only enroll their kids in a health plan after they got sick and costing the companies millions. Parents with healthy kids would not pay into the health insurance system in advance because they knew they could join later at any time.
To address this Health Insurance issue, the State of California has done two things:
1) Told insurance companies that if they don’t offer under 19 insurance they cannot sell any individual health insurance in the state for 5 years. Many claim this punishment would teach companies to not over look our students and children.
2) Created an enrollment period from Jan 1. to March 1 (or in the month after their children’s birthdays) where parents can sign up their kids on child-only policy and they will be approved regardless of health condition. If under 19 individuals sign up during this time the most they would be charged would be 2x the best rate. Those signing up outside the enrollment period could be charged a much higher rate.
In response to these new state insurance law, many companies the companies — including Aetna Inc., Anthem Blue Cross, Cigna Corp., Health Net Inc. and UnitedHealth Group Inc. — resumed sales of child-only.
“The law is only effective if parents take advantage of it — the time is now,” said Assemblyman Mike Feuer. The trick is to educate parents that they need to sign up their kids before March 1 or during the month of their birthday to take advantage of the new law.
Anthem Blue Cross of California announced today that it has received the go-ahead from the California Department of Insurance to begin selling 11 plans that are now compliant with the Patient Protection and Affordable Care Act (PPACA) mandated benefits.
They are accepting paper applications now and expect online applications to being in one week. All of the new plans will continue to have an initial 12-month rate guarantee.
Anthem said that they are “continuing to work with the California Department of Insurance in order to have the remainder of our PPACA compliant plans completely reviewed and ready for the Individual market as soon as possible.”
Still pending final approval are:
* SmartSense Plus
* ClearProtection Plus
* CoreGuard Plus
* Lumenos Plus
We will update this insurance blog when new plans become available.
Anthem Blue Cross announced today that it has begun the process to remove lifetime maximum payouts to its health insurance plans. The recent health care reform legislation states that insurance plans can no longer have lifetime and annual dollar limits on “essential health benefits” as soon as September 23, 2010.
Since the U.S. Department of Health and Human Services (HHS) has yet to clarify its definition of “essential health benefits,” Anthem Blue Cross has come up with the following list of the services they believe will be affected:
Alcoholism-related services
Ambulance services
Asthma education
Bariatric surgery
Chiropractic manipulation and osteopathic manipulation services
Diabetic supplies
Diagnostic services
Durable medical equipment
Enteral formula and food products
Hearing aids
Home health care
Hospice
Infusion therapy
Kidney disease treatment
Mental health/substance abuse
Ostomy supplies
Outpatient occupational therapy
Outpatient physical therapy
Outpatient speech therapy
Pharmacy
Physician office visit (diagnostic services)
Preventive services
Prosthetic devices/limbs
Skilled nursing services
Prosthetic devices/limbs
Skilled nursing services
Transplant services
Treatment of temporomandibular joint disorder (TMJD or TMJ)
Anthem states that the listed services still may be subject to copays and other cost shares and will be phased in over time. Annual dollar limits of at least $750,000 will be allowed for plan years from September 23, 2010, to September 23, 2011. Annual dollar limits of at least $1.25 million will be allowed for plan years from September 23, 2011, to September 23, 2012.Annual dollar limits of at least $2 million will be allowed for plan years from September 23, 2012, to January 1, 2014. After January 2014 there will be no lifetime limits and annual dollar limits.
Anthem Blue Cross of California announced today that they have resubmitted new rate requests with the California Department of Insurance and Department of Managed Health Care. According to the company the average increase is 14% and, if approved, would be effective on September 1, 2010. The rate action is expected to affect 602,500 Anthem Blue Cross members.
“We realize we made mistakes in our prior rate filing,” said Anthem in a memo to its agents. ” To avoid future mistakes, we’ve updated processes, such as including an external third party review and a rigorous internal peer review process by actuaries who are independent of the Individual business.” The company claims that the new rate increase comply with the Medical Loss Ratio (MLR) standard of the new health care reform law.
Will Anthem Profit from Proposed Hikes
A followup memo also stated that Anthem would not make any profit from these rate hikes: “With these filings we expect to continue to lose money on the Individual business in California again throughout 2010. Current estimates indicate that we can expect to lose more than $100 million in the California Individual market in 2010.”
California state requires that insurers notify members of rate adjustments at least 30 days prior to implementing any
change so members should get an official notification in Aug. As soon as Medicoverage knows the exact amount of individuals rate action or any other affordable family insurance options, we will send them on to our members. Just to clarify, rates for Anthem California members will stay the same until further notice.
Anthem Blue Cross health insurance company recently contracted with the Los Angeles based behavioral health provider, College Health IPA (CHIPA). The company will offer professional behavioral health services for Anthem Blue Cross members. While currently being piloted in the greater Los Angeles area, the company hopes to expand statewide to the entire CHIPA network of 300 plus behavioral health practitioners.
According to Anthem “This agreement is representative of the work we are doing towards payment restructuring programs on behalf of our customers. It also offers customers a reduction in behavioral health care costs.” How CHIPA will save money is unclear. It looks as though CHIPA utilizes its own contracted physicians to provide inpatient professional services to somehow save money.
The following is a list of Anthem Blue Cross Network Hospitals Participating in CHIPA Pilot Program. Note: not all Hospitals are participating.
Aurora Charter Oak
Aurora Vista Del Mar
BHC Alhambra
Canyon Ridge
Cedars Sinai
Chapman Medical Center
College Costa Mesa
College Hospital Cerritos
Community Medical Center , Fresno
Cornerstone of Southern CA
Del Amo Hospital
Glendale Adventist Medical Center
Good Samaritan of Bakersfield
Hemet Valley Medical Center
Henry Mayo Newhall Memorial Hospital
Hoag Memorial Hospital
Huntington Memorial Hospital
Little Company of Mary
Loma Linda
Northridge Hospital
Redlands Community Hospital
Riverside Center for Behavioral Medicine
Mission Hospital, Laguna Hills (Formerly South Coast Medical Center)
St Joseph’s Hospital of Orange County
Tarzana Treatment Center
Wellpoint CEO Angela F. Braly responded to Obama’s weekly address with a formal letter saying among other things “I was disappointed to hear you repeat false information regarding WellPoint’s coverage of breast cancer.” She also says that, “If we are going to make this law work on behalf of all Americans the attacks on the health insurance industry—an industry that provides valued coverage for more than 200 million Americans—must end.” We were able to track down the most recent one on may 8th. And we have included it below.
You will see it does mention Wellpoint / Anthem by name regarding price increases but we don’t see any reference to breast cancer recissions as featured in her letter. Here is the letter Braly sent to Obama regarding Wellpoint and Anthem health insurance. Check it out and let us know what you think:
Dear Mr. President:
I was disappointed to hear you repeat false information regarding WellPoint’s coverage of breast cancer in your weekly Presidential radio address as a demonstration of your Administration’s commitment to strong patient protection. Mr. President, I will tell you the same thing I told HHS Secretary Sebelius in a recent letter, your statement grossly misrepresents WellPoint’s efforts to help prevent, detect and treat breast cancer among our 34 million members.
To be absolutely clear: despite your claims, WellPoint does not single out women with breast cancer for rescission. Period.
The actual facts could not be clearer. In 2009, WellPoint covered the treatment of approximately 200,000 women with breast cancer at a cost of nearly $2 billion. During that same period, there were four cases nationwide where the issue of breast cancer or the possibility of breast cancer was identified in a rescission, but they were not singled out because of their breast cancer. Clearly, covering the treatment of close to 200,000 while rescinding four policies should make our intent in this regard quite clear. Our policy on rescissions has always been that it is based on fraud or misrepresentation - a policy consistent with that contained in the new legislation. In fact, we adopted the precise policy of the new legislation before any other insurer.
We should also note that we cover screening for women 40 and older, 10 years earlier than the guidelines published by your own US Preventive Services Task Force. We made this decision because we know that early detection is the key to survival, with a 5 year survival rate of nearly 100% when diagnosed at stages 0-1. This also reduces costs for the entire system by avoiding the nearly ten-fold increase in costs associated with treatment beginning after stage 3.
Mr. President, this country has a long history of coming together after tough debates. The implementation of the new health care reform law should be no different. If we are going to make this law work on behalf of all Americans the attacks on the health insurance industry—an industry that provides valued coverage for more than 200 million Americans—must end. We believe that our recent action to adopt many of the insurance reforms earlier than required by law is an indication of our willingness to work with your Administration to achieve this objective.
We agree that healthcare costs are rising at an unsustainable rate. While we continue to strive to make healthcare coverage more affordable for our members, we know that there are many causes for rising costs. Some of the most concerning cost drivers include inflation in the cost for medical services provided, increases in utilization, or the frequency with which these services are provided, and the increased cost borne by the insured population when healthy individuals choose not to carry health care coverage. These issues are of critical importance to all Americans and will require solutions that include all stakeholders in healthcare, business and government. In fact, we have repeatedly asked to meet with Secretary Sebelius, but have not yet received a response. This is simply not productive and not in the best interests of Americans.
We share your vision for a better America and look forward to working with you and your Administration.
Anthem’s Blue Cross of California announced today that it has launched a new set of health insurance plans called Premier. According to the company the offer unlimited office visits and richer benefits for preventive care and prescription drugs.
The plans which are now available for quotes now but start April 1, 2010 include the following:
$7 million lifetime payout for medical cost per member
Annual eye exams
Unlimited doctor office visits with the deductible waived
If you currently have a policy with Anthem Blue Cross of California, you may have received a letter stating that your price will be changing as of March 1, 2010. As you may have heard in the news, this health insurance rate action will be postponed until May 1, 2010 pending further review. If you are a Medicoverage client, we have already sent you an email with an update. Please let us know if you have not received it. If you are not sure if the rate action will affect you, please contact us, as not all members with Anthem Blue Cross plans are subject to the rate action. If you are one of the individual/families who are facing the proposed monthly increase, here is what is coming next according to Anthem:
What will happen to my billing now that the insurance rate increase has been postponed by Anthem?
1) You will receive a pre-recorded message from Anthem, which provides further explanation and information detailing specifics of the March 1, 2010 Rate Action postponement and next steps.
2) A letter will go out to you that will also address how the rate increase will affect you.
3) As of March 1, 2010 your will be billed at their prior rate of premium (the same monthlyprice you were paying in January or February)
4) If you have already paid your monthly premiums at the new increased rate, you can expect a refund by the end of March.
5) Clients who pay with recurring checking or credit card deductions will be debited their previous rate for their March 1, 2010 bill.
6) Clients not on automatic-withdrawal payments will have 30 days from receipt of their new bill to pay their premium.
The steps noted above will be automatically processed and there is nothing that you will need to do right now.
What if I have already changed or canceled my Anthem Blue Cross of California coverage?
Anthem encourages you to wait until May 1, 2010 before making any plan changes. You will receive a letter which will provides you with information on what you need to do if you have already changed or canceled their health insurance coverage and would like to be reinstated to their prior coverage. You can call us for assistance if you would like to discuss your plan options or alternatives.
Anthem Blue Cross Life and Health Insurance Company of California has contacted Medicoverage to confirm that they agreed to a request by the California Department of Insurance to postpone our March 1, 2010 rates to May 1, 2010, pending an additional third-party review. The review will be conducted by Axene Health Partners, LLC, retained by the California Department of Insurance. According to Anthem, they “have already conducted an independent third-party review, we welcome the additional scrutiny by the commissioner and are confident that our rates will continue to reflect anticipated medical costs and are established consistent with actuarial principles and state law.”
In addition to the email that we sent directly to our clients, Anthem will also be contacting policy holders to inform they of the delay. They will be sending pre-recorded messages to clients beginning Tuesday, February 16th, with details about how the rate action postponement of our March 1, 2010 rates will affect them and their insurance premiums. They will also be mailing letters to members this week, with details about how the postponement of our March 1, 2010 rates will affect them.
Just one day after we jumped on Steve Poizner for being reactionary in his handling of the Anthem rate hike, the California State Insurance Commissioner has asked Anthem to delay the proposed 3/1/2010 rate increases until 5/1/2010 to give his office time to investigate.
As of this blog posting, Anthem has yet to respond. While it is too early to know if the new rate hikes are justified or not. The new rate hike has angered many and has reinvigorated health care reform. Check out this quick sampling of sound bites:
“I can think of no better example of why we need health insurance reform,” said senator Diane Feinstein.
“They (Anthem) have clearly made themselves the poster child for why we need health insurance reform,” Assemblyman Dave Jones.
“If we don’t act, this is just a preview of coming attractions. Premiums will continue to rise for folks with insurance; millions more will lose their coverage altogether; our deficits will continue to grow larger. And we have an obligation—both parties—to tackle this issue in a serious way.” President Barack Obama
So it looks like this rate action is now a political issues. We will have to see how that affects customers who have to pay for the insurance plans. We will keep you posted.
The opinions expressed in this blog do not necessary reflect the opinions of Medicoverage Inc. Anyone is free to participate in the Health Reform debate on this site.
Today California Insurance Commissioner Steve Poizner’s office shot a press-release-type email to all licensed California health insurance agents commenting on the recent Anthem Blue Cross rate increases scheduled for 3/1/2010. He wrote:
“IA>?,??,>m alarmed by the Anthem Blue Cross health insurance rate hikes, especially in a time when the recession has forced so many people into the individual health insurance market. State law requires that insurers spend at least 70 cents of every dollar of premium on medical care. I have instructed my department to hire an outside actuary to examine their rates line by line to ensure they are complying with this state law. If we find that their rates are excessive, I will use the full power of my office to bring these rates down.”
While I commend Mr. Poizner’s commitment to keeping prices low, I need one thing clarified. Since health insurance companies have to get all rate actions reviewed by the state before they can increase rates, wasn’t he aware of these new rates before today? When was he exactly “alarmed?” Was it when he learned of the new rate or when it became a news issue? We knew about these proposed rate hikes weeks ago.
Our California Insurance Commissioner should make sure that all increases to health insurance are justified and we are anxious to learn who or what is behind the rapidly increasing rates at Anthem. I hope, however, that in the future that cost issues are his active goal, not just a reactionary response that looks good in the papers.
Now that you’re forking money over every month for your Tonik health insurance, you might as well take advantage of the services available to you. Tonik Plans are underwritten by Anthem Blue Cross of California and that’s a good thing. Blue Cross is California’s largest health insurance provider, which has bargaining power and a ton of great services. Here are some tips to get the most out of your plan:
1) Stay in the Anthem Blue Cross PPO Network.
That’s the trick to keeping your costs down. Anthem Blue Cross has a huge network of doctors and hospitals and if you use the Blue Cross Network, your cost will be way lower. So know before you go. Click here to find a Tonik doctor in your network. Search under PPO (formerly know as Prudent Buyer) Network.
It’s kind of like a mini physical. You can get a Healthy Check once a year for 25 to 75 bucks. This link will explain more and help you find healthy check centers in your area.
4) Check that Tooth.
Dental insurance comes bundled with Tonik Plans, so you might as well use it. As long as you stay in network, you’ll find that cleanings, exams and x-rays won’t cost you anything. If you need a filling, you have a $25 dental deductible then the plan pays 80% and you pay the remaining 20%. Total dental benefits paid by Anthem Blue Cross are limited to a maximum of $500 per year. Use the Anthem Blue Cross doctor finder to find a dentist in your network. Note: If you don’t get your teeth cleaned on a regular basis, you’ll soon have stank breath- so do us all a favor and make the call.
5) Pay Your Bills.
The number one reason why individuals are dropped from their plans is because they haven’t made a payment on time. Your bill is usually due on the first of the month. If you chose paper billing you will have to pre-pay for two months and there is a two dollar charge for the paper option. Want to save the earth or just having trouble remembering to get that check in the mail? Visit the Anthem CA section to access forms to fill out an automatic checking (or CC) withdrawal form. It takes 2 minutes and it can help ensure that you stay covered.
Medicoverage is an authorized independent agent. Benefits above are subject to change.
