What’s the latest news for August, 2013 with Health Care Reform

The biggest news this summer regarding the Affordable Care Health Act is the fact that the mandate for employers with more than 50 employees will be postponed until 2015. The group exchange plans are called SHOP and will still be offered in the Ca. exchange.
Anthem, the largest carrier in Ca. will not participate in the SHOP. This leaves Health Net, Blue Shield and Kaiser as main participants.

With individual plans in exchange all systems are going ahead. In previous years, the first question I would ask when a prospective client would call is “what are your pre existing conditions?”. Now with the health care reform system in place as of January, the first question I will ask is “What is your income?” If one makes between 150% and 400% of the federal poverty level they will likely receive a subsidy.
To translate that into real income, a single person making under $45,000 per year, a couple making $62,000 and a family making $94,000 will be eligible for a subsidy

As mentioned previously , there are 4 plans available in the exchange. The silver plan is the only exchange plan eligible for a subsidy based on income.
The Silver has a $2000 deductible.
Bronze has $5,000 deductible.
Platinum and Gold have no deductibles. All have coinsurance. I may be reached for more details.

Many have asked what type of plans will be offered outside of exchange and yes there will be options. The main reason to look outside to private carriers is because private carriers offer richer provider networks and maybe premium amounts. Since we don’t have rates for either the exchange or private carriers as yet, it’s difficult if not impossible at this point to make an informed decision. Brokers have been told the Ca. Covered /healthbroker.com web site will have physicians and hospitals networks listed on their website.

All those on grandfathered plans will be able to keep their current plans and will have lower rates. We’ll see…………..
All those who bought coverage after March 2010 will be moved to a plan that contains 10 essential benefits as outlined in the Affordable Care Act.

What if I have Aetna individual insurance?

Aetna recently made the announcement that it will no longer offer health coverage in the state of California.
They offer coverage in other states and haven’t made a decision regarding whether they will offer any individual plans nationwide.
What does this mean to those who have “grandfathered coverage”. It means you will lose your grandfathered status, unfortunately.
In October anyone may apply for and receive coverage either in “Covered Ca”or if one is not eligible for subsidies, in a private company such as Blue Cross, Blue Shield or Health Net.
The loss of grandfathered insurance is unfortunate only because the rates will be lower then the new plans available after March of 2010.
The advantage of joining Ca Covered is the subsidies but be aware the CC asks what one’s income is and all information is passed along to the IRS so it’s important all give accurate information.

What’s happening with health care reform

In California we have 6 million uninsured residents. This is the largest uninsured market in any state in the country.
It’s going to be a challenge to reach all the uninsured in Ca. Starting this summer there will be a blitz of advertisements and radio announcements.
The state is most anxious to reach the young uninsured men and women because in order for the premiums to stay affordable, it’s important keep low premiums.
Younger people generally have fewer claims.
The subsidies look generous, so many{especially families} will save money.
Since Medicaid has been expanded it’s possible to have a child on the Cal Medicaid and a parent receiving a subsidy.
I recently took an online seminar with “California Covered” and was very impressed with their on line application.
One of the first items one looks at is premium and how it’s established. You will place a certain income within application and then the application will tell you retail cost and cost with subsidy. One will still need an agent to give guidance and tips to those applying. I was surprised to find Blue Shield’s PPO offers only 36% of their network to “California Covered” plans.
Kaiser is one of the most surprising because their premiums are priciest of all the HMO’s.
One of the most important issues will be the availability of Drs. available in each network.
As a health broker, I will be available to help guide you through the process of going through California Covered or a private company.
Kathy Hope

Health Care Reform for Individuals

There are four “metal” plans available under Ca Covered”. All are guaranteed plans where it doesn’t matter what pre existing conditions one has.
In the past, the first question I would ask a clients is “what are your pre existing conditions”. Starting in January, the first question I will ask is what is your adjusted gross income?{line 32 on tax form}. this is a huge difference from the past and will take a bit of adjustment both me asking and client giving this information to broker.
The exchange plans are all called Ca. Covered and there are four levels of coverage.
The plan with highest deductible and copays is the Bronze. It has a $5,000 deductible and has most out of pocket costs{40%}.
The next is the Silver which has a $2,000 deductible and is paid 70/30%
Both the Gold [80/20%} and Platinum 90/10% have no deductible.
These plans are designed to help those who in the past were not able to afford coverage. I will have an online calculator to advise each person who contacts me whereby I will enter their age, income, zip code and let them know what their premium will be for Ca Covered.
If one’s income is too high to qualify for subsidies, thee will be plans designed from all carriers doing business in Ca.
An example of the cost sharing subsidies available within Ca Covered would be a family of four making $44,000 . They would receive a subsidy
of $4,740 that will be used to pay for health insurance. The premium will be reduced to $169 per month.
A family of four making $80,000 per year would pay premium of $633 Quite a savings!
All current policy holders will be routed to plans which include the 10 essential benefits on January 0f 2014. This is positive in that all individual plans will have richer coverage but depending on income, more in premiums.

Individual Health Insurance

I have so many prospective clients calling me about individual health insurance who have pre existing conditions.
Many of them don’t them don’t realize they do have conditions that will frowned upon by the major insurance carriers.
Since most people apply through on line applications, I don’t see their answers therefore many mistakes are made.
It’s important to read application very carefully because each carrier will ask about different time frames.
One insurance company will request answers during the last 2 years , some last 5 years etc.
I had one recent client who applied and had mild diabetes under control with medication and said she was very healthy.
When applying for health coverage, she was denied.
If she had mentioned the diabetes, I would have guided her to another carrier.
It’s important to mention all meds and health challenges to agent so you may be underwritten without problems.
Some are not denied but rated up substantially.
This means if you were quoted $200 per month for your premium , you can be raise das much as 50 to 75%.
In January of 2014, there will be no such thing as pre existing conditions.
However rumor has it that premiums will be much higher because all carriers will have to include the 10 essential health benefits outlined in the Health Care Reform Act.

Health insurance for children

Child only health coverage is a health plan for a child or children only.

The Affordable Care Act provides guaranteed coverage for children regardless of their pre existing conditions. Your child is eligible all year long however on their birthday month, they cannot be rated an extra amount. If you apply for health coverage any time outside of birthday month, the insurance company may double premium. Once the child’s birthday comes, the premium will go down to normal rates.

If your child was without insurance for 6 mos or more, he/she will have an increase of 20% until birthday month. It’s very important to have continuous coverage for your child.

If a family applies for coverage with children and they have not had previous coverage , the children will be rated 20% higher outside birthday month. The only exception to this is Blue Shield.

Before your child turns one year old, the premiums are  high because the insurance companies experience is  children under one year old experience higher claims than those over one year.

If your family has no previous health coverage and applies to Blue Shield , there will be no additional premium




Health Care Reform

Covered California is the new health insurance exchange or marketplace  which will show all what coverage is offered and whether one will be eligible for tax credits.

There will be four plans offered. Bronze plan which covers all claims at  60%, Silver at 70% Gold at 80% and the Platinum at 90%.

Every plan whether it be private carrier or exchange must cover 10 essential benefits as follows. Hospitalization, Emergency Services, Maternity/ newborn care, Mental health and Substance abuse services, Prescription coverage,Physical therapy, Lab services, Preventative coverage and Pediatric services

The exchange will be open for business on October 1, 2013 and coverage will be effective on January 1 2014.

The biggest advantage with the Ca health insurance exchange will be it’s guarantee of coverage for all, no matter what pre existing conditions exist. For many years many were locked out of purchasing health coverage because of health conditions.

As for rates,  people over 40 will pay less and younger people will more. This will happen because the carriers presently charge fives times more for a 60 year old than a 20 year old. With the exchange it will be 3  times more for a 60 year old versus a 20 year old.The unknown are premiums.

The only down side will be the limited networks rumored to be in exchange. In order to understand the tax credits eligible for some, it’s very important to have  professional advise.

I am enthusiastic about the monumental changes coming.




The rates will be available October of 12013


Doctors Propose Solution to Projected CA Doctor Shortage

There’s been a lot in the news about a projected shortage of doctors here in California. The LA Times is saying that only 16 of 58 counties have the quantity of doctors recommended by the federal government.

Up until now the suggestions for taking care of this situation have been to use nurse practitioners and other medical professionals who are somewhat trained but not to the degree of doctors to fill in the gap.

Doctors are concerned about the quality of care that will be available via the suggestion of “filling in” so to speak with qualified to less than 100% levels… soooo in response a group of doctors submitted a package of 5 bills for addressing the shortage without expanding the practices of non-physicians.
It also targets incentives and “hows” for having “care” be provided in underserved areas.

Bills included in the proposed package are:

  1. SB 21 and AB 27, advocates that $15 million annually from the state general fund be provided for the new UC-Riverside School of Medicine
  2. AB 565,  expands the Steve Thompson Loan Repayment Program that helps repay medical school loans in exchange for individuals agreeing to practice in medically underserved areas;
  3. AB 1176, creates additional residency positions in medically underserved communities by implementing insurer fees
  4. AB 1288, requires the Medical Board of California to prioritize applications for physician licenses from individuals who agree to practice and treat underserved population(s).

What do you think?  We’ll have to wait and see what happens here. They are going the way that the teaching profession went to encourage young college students to become teachers.

Shall I enroll in Cobra coverage?

Generally the cobra option is a lot more in premium than an individual plan.The good news with cobra coverage is the benefits usually have a low deductible but you pay handsomely for the rich coverage.The better news is with an individual plan, the deductible is high but the premium is about half the cobra coverage .

If you’re healthy and have no pre existing conditions, you will about 1/2 the premium amount for  an individual plan.

The cobra coverage will  take you to January of 2014 when you’ll be able to purchase a guaranteed coverage plan through either a private company or on the exchange . At this point, children are accepted guarantee issue however they may be charged 2X the premium.

Stay tuned for more