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.