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