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%.
Ouch!
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.