Fixing Obamacare at Capitol Hill

Last week, I and my fellow board members from our agents and brokers’ Association of Health Underwriters (AHU) gathered at Capitol Hill in Washington, D.C. to visit with Congressmen and women from both sides of the aisle to discuss issues and challenges that affect health insurance for Americans. During the past 18 months since the ACA rollout, agents and brokers exceeded everyone’s expectations by excelling in their jobs, while the Govt. Exchanges and all other entities fell below expectations. Our association has received the recognition of lawmakers and regulators, and we strive to promote a system that would be more affordable, equitable, less bureaucratic to consumers and employers, while offering more choice and competition, and reducing the burden on taxpayers.
Thank you for your feedback and concerns which I incorporated into our conversations with legislators.

Phil Lee
Lee Health Insurance Services

Obamacare: Enroll by Sunday 2/15 or Pay a Penalty

(Please disregard this if you have an Employer Group plan or have Medicare.)

For those of you who have not already enrolled into an Individual health plan, the enrollment deadline is this Sunday Feb. 15th.
After the Feb. 15th deadline, you will have to wait until the end of the year to enroll for Jan. 1, 2016. If you are uninsured, you may also face a penalty when you file your tax return in April 2016.

Possible Extension:
For those of you applying through Covered California for an On-Exchange health plan, if you start an online application before 2/15 but are not able to complete it on that day, we, as agents, have been given an extension to help you complete it, by 2/24. This extension is not available to the public and does not apply if you do not start an application by 2/15.
If you need help, please call us at 925-284-2000 or email .

Phil Lee
Lee Health Insurance Services

Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan

Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan

To avoid a penalty, the deadline to enroll into an individual health plan is Feb. 15th, 10 days from today. If you submit an online application by that date, you will be able to secure an Effective Date of March 1st. If you miss this deadline, you may not enroll again until the end of 2015.
This deadline does not apply to you if you experience a qualifying event during the year, such as a loss of Employer group coverage, a change in family status such as a marriage, divorce or newborn, a move out of the area, etc.
If you are uninsured, or insured only with a temporary or non-creditable health plan, you may face an IRS-assessed penalty for 2015 of up to 2% of your household income. (This is up from 1% in the 2014 tax year.)
If your estimated 2015 household (MAGI or Modified Adjusted Gross Income) is between 138% and 400% of the Federal Poverty Line (FPL, equivalent to roughly between $16,106 and $46,680 annual income for a single person household), you may apply to Covered California for an APTC (Advance Premium Tax Credit or Tax Subsidy) to help pay the monthly premium on a creditable health plan. If not, you may apply for an Off-Exchange health plan at the same price without a subsidy. We can help you with both. If you income is below 138% FPL (or your children below 200% FPL), then you may qualify for Medi-Cal (California’s Medicaid).
Please call us at 800-286-7445 if you need help.

Philip W Lee
Lee Health Insurance Services
Employee Benefits and Health Insurance

Alert to Individuals who Received Tax Subsidies or APTC to Pay for Covered California Health Plans – Form 1095A

(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

Re: IRS Form 1095A and Form 8962

Covered California, the California health insurance exchange, will shortly be sending out a form called the IRS Form 1095A to all individuals and families who received tax subsidies in 2014 to help pay for their Individual/Family health plans. This is required by the federal ACA law (Obamacare) and will be sent out by Jan. 31st.
These forms will show, in detail, by month, the amount of APTC (Advance Premium Tax Credit or Tax Subsidy) that the recipient received in helping pay the premium for their subsidized health plans in 2014.
These individuals will be required to use this Form 1095-A to obtain information needed to complete Form 8962 (Premium Tax Credit (PTC)). They must then complete IRS Form 8962 and file it with their 2014 Tax Return by April 15.
Those who enrolled into Off-Exchange health plans need not be concerned, since they did not receive any tax credit, you will not receive a 1095A. Only those who applied for a health plan through Covered CA AND who received an APTC to reduce the premium paid, will be receiving these 1095A forms.
Those enrolled into Medi-Cal (California Medicaid), those on Medicare, and those enrolled on employer group plans are not affected by the above.

Disclaimer: We are not qualified to give tax advice. If you have any questions concerning either Form 1095A or Form 8962, please contact Covered CA, your tax adviser, the IRS or go to the IRS website links below:

Philip W Lee, MBA
Lee Health Insurance Services

Last Minute Alert: Covered CA Deadline Extended to Dec. 21 for Individual Health Plan Enrollments

(Note: This alert relates only to Individual and Family health plans.  It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

We just learned tonight that Covered CA, the State Health Exchange, has extended the previous deadline for Jan. 1 enrollments, from Monday Dec. 15th to Sunday Dec. 21st at midnight.  This extension applies only to Individual plans, and only to Consumer and Agent-assisted enrollments.

Covered CA also states that enrollments completed after Dec. 15th may see delays in invoicing as well as delays in proof of enrollment procedures.  To facilitate faster enrollment, they encourage submitting applications as soon as possible, but no later than Dec. 21st.

Please call us, Lee Health Insurance Services, at 925-284-2000, if we can be of assistance.


Philip W Lee MBA

Lee Health Insurance Services, BLIS Corporation


Health Plan Enrollment Deadlines

This is a friendly reminder of several deadlines that are approaching.

Deadlines for INDIVIDUAL & FAMILY HEALTH PLANS (Either On-Exchange Covered CA plans or Off-Exchange plans)

(1) Deadline to enroll or change plans for a Jan. 1st effective date is Monday, Dec. 15th

(2) Open enrollment runs from 11/15/14 to 2/15/15. The deadlines corresponding to each effective date are:

Deadlines for each Effective Date

12/15/14 for 1/1/15

1/15/15 for 2/1/15

2/15/15 for 3/1/15

(3) If you are currently receiving a subsidy, then you must Renew by logging into Covered CA with your User ID and Password in order to re-certify to continue receiving the subsidy. (4) If you are uninsured, you may enroll by Dec. 15th to avoid a penalty in 2015.


(1) Groups on Grandfathered or Grandmothered plans will already have renewed on Dec. 1st.

(2) All groups, whether Grandfathered or Grandmothered will have a chance to change to new ACA plans with another insurance carrier on Jan. 1st.

(3) If you are dissolving an Employer Group plan and allowing employees to buy individual plans, they need to enroll by Dec. 15th for a Jan. 1st start. (Note that Individual health plans have significantly smaller Provider Networks than Group plans, and smaller Drug Formulary lists. Each of your employee will need to research their providers and formularies carefully before making a switch. Not all employees will qualify for subsidies. Employers are not allowed to use pre-tax dollars to pay for employees’ Individual plan premiums.)


(1) The deadline to change from a Medicare Advantage MA-PD plan (HMO or PPO) to another is Dec. 7th.

(2) The deadline to change from a Medicare Prescription Drug PDP Plan to another is Dec. 7th.

(3) For Medicare Supplement (or Medicare Gap) Plans there is no deadline and no renewal is necessary. These plans will continue as long as you continue paying the premium.

(4) For those of you who received termination notices from Scan Health and Health Net Medicare Advantage plans, you must enroll before Dec. 31st for a Jan. 1st effective date. Since some carriers will be closed during the holidays, you should submit these applications 2 weeks before Dec. 31.

(5) If you are on a Medicare Advantage MAPD plan and wish to switch to a Supplement plan and a PDP plan, you may do so, guarantee issue, only under 13 specific conditions. Otherwise, underwriting approval may be required and the timing of the switch can be tricky. The ideal time to make a change is between Oct. 15 and Dec. 7th, and as early as possible during this window. This should not be done without the assistance of a knowledgeable agent.

Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.

Phil Lee

Open Enrollment and Renewal for 2015 Individual Health Plans

(Please Note: This information pertains only to those of you who are on Individual or Family Health plans.  This does not affect either Employer Group plans or Medicare.)

This past year just flew by.  But Open Enrollment is upon us again.  The Open Enrollment period runs from Nov. 15th through Feb. 15th.  (Any plan changes to start on the first of a month must be made by the 15th of the previous month.)   All of you should have received letters or emails from either your insurance carrier or from Covered CA, or from both.  Many of you may not need to do anything at all for your plans to continue.  However all of you who received subsidies through Covered CA will all need to take action.  Details on how to do this are at the bottom of this email.

NOTE: If you require assistance, but we are not your agent, you may designate us as your agent in order to receive our assistance.

If you have an ON Exchange Individual Health Plan

(i.e.  you obtained your Anthem Blue Cross or Blue Shield or Kaiser or Health Net plan through Covered CA, either with or without our assistance as your agent.)

You must “Renew” your plan if you want to continue receiving your subsidy for the 2015 year.  You do this by logging into using your User ID and Password.  Government regulations require that you so this in order to continue the subsidy.  If you don’t do this, the premium for your plan will jump up to the full non-subsidized rate and you will be billed for that.  Some may also lose the cost reduction feature on the Silver 70+ AV plans.  Details on how to do this are at the end of this email.

If you have an OFF Exchange Individual Health Plan

(i.e. you obtained your Anthem Blue Cross or Blue Shield or Kaiser or Health Net or Cigna health plan, outside of Covered CA.  You did not apply for a subsidized plan.   You may or may not have used us as your agent.)

Please read the letters from your insurance carrier carefully.  Most of your plans will continue and you may not need to do anything to continue.  However for some of you, especially those who are on Health Net plans, they have cancelled some plans and changed many from PPO to EPO.  You may want to research new carriers or plans.

How to “Renew” Your Covered CA Subsidized Health Plan

Log into your account on Covered CA by going to: and once you are on your account page choose Renew (yellow box).   Next will appear Household Plan Selection and click Renew Health Plan (yellow box).

On the next page, two boxes will appear: Choose either Keep the Plan you now have or Shop for a different plan.

If you want to keep your current plan click Keep (yellow box) and checkout (yellow box) check all boxes, put in your pin number, sign and click Enroll (yellow box). On the next page you can print out your confirmation page and make sure you click Done (yellow box). Submit your payment to the carrier no later than December 26, 2014 by either calling your carrier or logging into their website to pay online.

If you want to change your plan when you are on the page that says: Keep the plan you now have or Shop for a different plan you will “remove your plan” (yellow box) first and then click on “Shop for a different plan”. Next page you will review all plans and choose a new plan, check out, check all boxes, put in your pin number, sign and click “Enroll” (yellow box). You can print out your confirmation page and click Done (yellow box). Submit your payment to the carrier no later than December 26, 2014 by either calling your carrier or logging into their website to pay online.

Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.

Phil Lee

Clarifying Confusing Names For Obamacare Plans

We have been preparing for the next Open Enrollment period for purchasing individual and family medical insurance plans, which begins on November 15, 2014 and ends on February 15, 2015.

One thing I’ve discovered is that the insurance companies, California State government and the Federal government all have different names for insurance plans offered through Covered CA, the state-run exchange for buying health insurance.

Here’s a list of all the different names I’ve come across in CA that essentially all refer to the same plans, the Covered CA plans.

  • Covered CA plans
  • Obamacare plans
  • Exchange plans
  • CA State Exchange plans
  • Marketplace plans
  • HBEX (Health Benefit Exchange) plans
  • HIX (Health Insurance Exchange) plans
  • Health Care Reform plans
  • PPACA (Patient Protection & Affordability Act) plans
  • ACA (Affordable Care Act) plans
  • Federal plans
  • On-Exchange plans

These names are confusing and misleading, as many of you discovered last year.  The solution is to simply remember that there are 2 markets: On-Exchange and Off-Exchange.

1) If you do not qualify for a subsidy you do not have to buy from the Covered CA website.  You can buy Off-Exchange plans with no Govt. subsidy.  You can avoid the technical problems and onerous information requirements of the Covered CA website by applying for a plan through our website, or calling us at 925-284-2000.  There are no fees for our services and the premium for your plan is the same whether or not you use an agent.

2)  If you qualify for a subsidy due to your income, you can use our expertise as your certified agent to apply to Covered CA, and to receive ongoing assistance from us.  These are called On-Exchange Plans.   In fact, it is advisable to use a certified agent to apply to Covered California plans because they have up-to-date information on changing plan designs, provider networks, drug formularies, and a dedicated broker support team at Covered California for support.  Certified insurance agents enrolled between 40% and 80% of individuals, inside and outside of Covered California.

Applying for a subsidy (also known as the Advance Premium Tax Credit APTC) by applying to Covered CA may require you to submit documentation to verify information such as income, immigration status and employment. The information you provide is subject to verification by the IRS, Dept. of Homeland Security, Dept. of Labor, etc. either at the time of application or at a later date.

Here’s a simple chart to help you figure out which type of medical insurance plan you may qualify for in 2015:

The 2 Markets for Individual Health Plans
 ON Exchange
 OFF Exchange
Possible Tax Subsidy based on income
No Tax Subsidy
Marketplace OFF-Marketplace
Covered CA NON-Covered CA
Government Exchange NON-Government Exchange
Limited number of insurance plans Broader number of insurance plans


Please keep these terms handy when reading about or shopping for health insurance. When in doubt, call us at 925-284-2000.

The 2 markets for Individual Health Plans:

(1) On Exchange: Tax Subsidy based on income, Marketplace, Govt. Exchange, Limited insurance plans.

(2) Off-Exchange: NO Tax Subsidy, NON-Covered CA, NON-Government Exchange, Broader number of insurance plans.

As always, for our assistance, please call 925-284-2000 or go to

Phil Lee

Lee Health Insurance Services

Covered California Announces Extension of Deadline to April 15th

(This E-blast pertains to people buying individual and family plans only. Medicare plans and employer plans are not affected by this announcement.)

Covered California announced that they are extending the March 31st deadline to buy health insurance through its Exchange website to April 15th. There are conditions. You may fulfill these conditions by working with a Certified Insurance Agent, like me. We are prepared to help you. Please call us at 925-284-2000 or email

Re-cap of announcement from Covered CA:
1. If you were unable to create an online account or start your online application because of technical difficulties you can contact me, a Covered California Certified Insurance Agent, to explain that you attempted to get through on March 31 and experienced difficulties. You will have until 11:59 p.m. April 15 to complete your application and choose a plan. Your coverage will be effective May 1.

2. If you created an online account and completed the first page of the application by 11:59 p.m. March 31, 2014, you will be able to complete your application for the open-enrollment period, either by yourself online or with my help. I am a Certified Insurance Agent. You must complete your application and select a plan by 11:59 p.m. April 15. Your coverage will be effective May 1.

In addition, for those applying to OFF-Exchange (i.e. non-Covered CA, non-subsidy) plans, we understand that Blue Shield and Health Net’s online application links are both still working.

Please call us at 925-284-2000 if you still need help getting coverage.

Phil Lee
Lee Health Insurance Services


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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445