Anthem Blue Cross to Discontinue Individual Health Plans in Most Counties in California

Anthem Blue Cross announced that they will discontinue selling Individual medical plans in CA in 2018 except for three counties, Santa Clara, Stockton/Modesto, and Redding.

I received the following email from Anthem to agents and brokers last week with details about this decision. Please click on the link below:

Anthem Announcement

Please review the following to be sure that you will actually be affected by this:

  • This change only affects those on Individual Health Plans, NOT Employer Group plans or Medicare plans.
  • It affects both On Exchange (Covered California), as well as Off Exchange health plans.  It affects both subsidized as well as non-subsidized plans.
  • It does not affect “Grandfathered” plans.
  • It will take effect on Jan. 1st, 2018.
  • This change does not affect these 3 counties: Santa Clara, Stockton/Modesto and Redding.

We might be able to help you find alternatives as soon as the insurance carriers such as Blue Shield, Health Net and Kaiser release their new rates for Jan. 1, in either September or October.

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

925-284-2000

http://www.health-insurance.com

www.linkedin.com/in/philwlee  

Covered California – Urgent Last Minute Alert

(This information concerns those who enrolled into Individual and Family Health Plans through the Government Exchange – Covered California – and received a Subsidy or APTC.  It does NOT concern you if you are either on an Employer-Sponsored Group Health Plan or a Medicare Health Plan. This information pertains only to California and may not apply to other states.)

As a courtesy, we are passing this information onto you.

December 19, 2016

 

Consumer Outreach for Consent for Verification

Yesterday, Covered California sent an email to consumers that are at risk of losing their Advanced Premium Tax Credit (APTC) and/or cost-sharing reductions for their 2017 health insurance coverage.  Consumers need to ensure that they have provided their Consent for Verification as this allows Covered California to electronically verify their eligibility for tax credits.

The following two fields are provided to help identify those consumers who need to provide consent.

  • Years of Consent – provides the number of years the consumer provided consent to using their information for verification purposes.
  • Date of Consent- provides the date the consent was provided by the consumer to use their information for verification purposes.

Without taking action now, consumers who have not updated their consent will lose their premium assistance including federal tax credit and/or cost-sharing reductions (lower copayments, coinsurance and deductibles). Read our Consent for Verification Quick Guide for additional information.

LAST DAY to Enroll for January 1 Coverage

Consumers only have until midnight tonight, December 19, 2016 to enroll in a health plan for coverage beginning January 1, 2017. Plans selected after this time may have a February 1 or March 1, 2017 coverage start date.

 

Covered California Service Centers

Consumers that need last minute application support can contact the Covered California Consumer Service Center for the Individual Marketplace at 800-300-1506, which will be open tonight until midnight.

 

Upcoming Outage

Sunday, January 22 from 8:00 p.m. to Monday, January 23, 2016 at 6:00 a.m.

Phil Lee
Lee Health Insurance Services, BLIS Corporation
800-286-7445
www.linkedIn.com/in/philwlee
www.Health-Insurance.com
plee@health-insurance.com
Employee Benefits & Health Insurance

Blue Shield of California Plans to Shut Down for 1 Week in September to Save on Payroll Due to Obamacare Losses

http://www.bizjournals.com/sanfrancisco/news/2016/08/11/exclusive-losses-blue-shield-california.html

As reported by the San Francisco Business Journal, Blue Shield of California will be closed from September 3 to September 12 while its employees take the week of Labor Day off. Although Blue Shield announced there will be some customer service staff working that week we assume the phone lines will be jammed for the entire week.

It appears that Individual, Small Group and Medicare departments are affected by the shutdown.
We do not yet know whether the Blue Shield member portal, broker portal or employer portal will be accessible and will reflect current information during the shutdown.
ALL APPLICATIONS FOR BLUE SHIELD PLANS SHOULD BE SUBMITTED AS SOON AS POSSIBLE SO THEY CAN BE PROCESSED WITH AN ID NUMBER ISSUED BY FRIDAY, SEPTEMBER 2. APPLICATIONS ARE CURRENTLY TAKING 10-14 DAYS TO BE PROCESSED.
This is an unprecedented announcement by an insurance company. We will do our best to provide service to our clients during this shutdown, but if Blue Shield is closed our ability to provide customer service will also be severely impacted.

(NOTE: This information relates only to Blue Shield of California, a taxpaying non-profit insurance carrier that operates only in California. Please do not confuse this company with Anthem Blue Cross, or any other Blue Cross or Blue Shield organization in states outside of CA.)

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

Understanding Special Enrollment Period (SEP) and Qualifying Events (QE)

(This information concerns Individual & Family Health Plans. It does not concern you if you are either on a Medicare Health Plan or on an Employer-Sponsored Group Health Plan)

The year-end Open Enrollment Period for Individual Health Plans ended on January 31, 2016.  However, certain individuals may still be able to apply for a health plan in 2016. This special circumstance is called the Special Enrollment Period (SEP).  You need to have a Qualifying Event (QE) to qualify.  Here’s what you need to know.

You can buy health coverage outside of the open enrollment period when you have a qualifying life event—through a special enrollment period (SEP).  Most SEPs last 60 days from the date of the qualifying life event.
Qualifying life events for a SEP include:

  • Getting married or entering a domestic partnership
  • Child aging off a plan
  • Gaining a dependent or becoming a dependent through marriage, birth, adoption, or placement for adoption or foster care
  • Permanently moving to a new area that has different health plan options
  • Employer coverage not being considered minimum essential coverage
  • Losing other healthcare coverage that is considered minimum essential coverage, such as due to job loss, termination of employer health plan by the employer or expiration of COBRA coverage
  • Returning from active military service
  • Change in eligibility for advance premium tax credit or cost-sharing subsidies

Please note that voluntarily terminating other health coverage or being terminated for not paying premiums is not considered a qualifying event.

All insurance companies will require written proof that you have an acceptable qualifying event.  When enrolling during an SEP, please make sure to include qualifying events verification documents in the application.

This is a link to Blue Shield of California’s interpretation of the ACA laws regarding SEP and QE’s.  Different carriers may have slightly different interpretations and requirements.

https://bliscorp.egnyte.com/dl/QJhtXag1KT

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

www.linkedin.com/in/philwlee   www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable

 

The Pitfalls of Leaving Original Medicare & Supplement Plan for Medicare Advantage HMO

(This information concerns Medicare Health Plans.  It does not concern you if you are either on an Employer-Sponsored Group Health Plan or on an Individual & Family Health Plan)

We frequently hear stories about seniors who made this change hastily because they attended a meeting, or an agent came to their home.  Frequently these agents would represent a limited number, usually just one, Medicare Advantage HMO plan.  They typically do not give prospects an adequate overview or understanding of the entire universe of plans in the marketplace because they have limited knowledge and products to offer.   They don’t fully explain the consequences of your making such a switch.

If you are contemplating such a change, you should not do so lightly.  You should only do this after much thought and research.  It’s not a matter of simply changing plans or changing carriers.  It’s nothing short of changing  from one world of plans, Original Medicare with Medicare Supplement, to another entirely different world of plans, Medicare Advantage.

These are the issues you must consider:

  1. This change may not be reversible in the future because Medicare Supplement plans are not guarantee-issue, except at age 65.  Supplement plans do not have an annual open enrollment period as Advantage plans do.   If you ever want to go back to Medicare Supplement from an Advantage plan, you will have to be medically underwritten and approved on your application before you will be enrolled.
  2. 90% of our clients choose Medicare Supplement F plans because of the freedom to choose their own providers anywhere in the country, and also because of the freedom from Copays, Coinsurance and Deductibles for all medical costs, excluding Rx.  However over the years, many non-clients have approached us for help to make the difficult transition from Medicare Advantage, such as Kaiser back to Original Medicare and Supplement.  This process is not easy, and is full of tricky timing and health approval issues.
  3. Medicare Advantage HMO plans like Kaiser Advantage or Scan Health require you to use only those doctors that are in their network.  You will not have the option to see any outside doctors such as from UCSF, Stanford, etc.  You will be required to obtain referrals and authorization for all specialists, procedures, etc.
  4. Advantage plans do not include Foreign Travel benefits.
  5. Kaiser Medicare Advantage does not cooperate with independent agents.  So we will not be able to service you on your Medicare plans at all.
  6. CMS (Center for Medicare & Medicaid Services) has ruled that Medicare Supplement F plans can no longer be offered to new enrollees after the year 2020. If you think you might want a Medicare Supplement F plan in the future, you must enroll before 2020.
  7. Medicare Trial Period and Medicare 24 Month Rule – Under very limited circumstances, Medicare beneficiaries who enroll in an Advantage plan at age 65 may have a 12 to 24 month Medicare Trial Period where they may switch back to Original Medicare, a Medicare Supplement plan and a Medicare PDP (Rx) plan, guarantee-issue.   But it must be done within 24 months from age 65 Medicare ICEP (Initial Coverage Enrollment Period).

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

Medicare Annual Enrollment Period (AEP) 2015

(This information concerns Medicare Health Plans. It does not concern you if you are either on an Employer-Sponsored Group Health Plan or an Individual & Family Health Plan)

Medicare Annual Enrollment Period (AEP) 2015

(A) When is the 2015 Medicare Annual Enrollment Period (AEP)?

Once again this year, Medicare AEP will run from Oct. 15th to Dec. 7th.

You may do the following during this time:

  1. Enroll or change your Medicare Advantage plan (MA-PD).
  2. Enroll or change your Medicare Rx (PDP) plan.
  3. Enroll in a Medicare Supplement and PDP plan (the supplement is not guarantee-issue).

(B) Is Medicare Supplement Plan F going away?

Yes, CMS (Center for Medicare Medicaid Services) has announced this year that they will not allow Medicare Supplement Plan F, the most popular supplement plan, to be offered after year 2020.

However, anyone who is already on an F plan at that time will be grandfathered and permitted to keep it indefinitely.

In other words, if you think that you may ever want a Plan F, you must enroll by 2020. If you lapse your F plan before 2020, you will never be able to get it back again. Those who will turn 65 after the year 2020 will unfortunately never be able to experience the benefits of Plan F.

(C) Are rates for frozen Supplement Plan F likely to skyrocket?

Some concerns were raised that the premium for F plans may skyrocket, after 2020, due to there being no new future new entrants into the risk pool. Although this is a possibility, it is unlikely to be a cause for alarm for the following reasons: (1) Unlike under age 65 plans, supplement plans are secondary payers (Medicare is the primary payer) and not subject to the brunt of the risk. (2) In the past when older supplement plans were frozen, such as the Anthem Classic J plan, there was no great increase in rates. (3) After the freezing of Plan F, other plans like G and N will still be available, although these other plans are not as comprehensive as F. (4) Even if premiums should escalate, the Birthday rule allows members to switch to like, or downgrade, plans, guarantee-issue, every year, on their birthday month.

The practical implication is that seniors may keep Plan F and take a wait and see attitude. If rates go out of line, then simply downgrade, guarantee-issue, on their next birthday.

We would be delighted to help you find affordable solutions to your health care needs.

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

Last Chance to Enroll into a Health Plan in 2015

(This information relates only to Individual and Family Health Plans, not Medicare or Group plans)

If you are uninsured and do not have a special Qualifying Event, Thursday April 30th is the last day that you may enroll into an Individual Health Plan using the Govt.’s special extension by claiming that you are unaware of the uninsured penalty.

If you apply by April 30th, you will receive a June 1st effective date. Otherwise, you will have to wait until the end of the year.
In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, most carriers require you to do so through a certified agent. Anthem Blue Cross further requires the application to be on paper through an agent.

At Lee Health Insurance Services we would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whomever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.
Phil Lee
Lee Health Insurance Services
800-286-7445
www.health-insurance.com

Extended Enrollment Deadlines for Individuals

(This information relates only to Individual and Family Health Plans, not Medicare or Group plans)

For those of you who are still uninsured or who just found out from doing your 2014 tax return that you have to pay a penalty, there is still time to enroll. If you are currently uninsured and can testify that you were not aware of the penalty, you may still enroll. However, there’s not much time left. The deadlines are:

April 15th, for a May 1st Effective Date.
April 30th for a June 1st Effective Date.

In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, you must do so through a certified agent or broker. We at Lee Health Insurance Services (800-286-7445) would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whoever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.

Covered California Application Problems

We are finding that many of you trying to enroll onto Covered California online got stuck or sent off to MediCal (Medicaid). E.g. if you happen to put an Employment End Date, you would likely be sent to MediCal.
We, at Lee Health Insurance Services, have figured out the “fixes” to these issues, and would be delighted to help you resolve them in order to secure coverage from Covered California.

Very sincerely,
Phil Lee
Philip W Lee MBA
Lee Health Insurance Services
Employee Benefits and Health Insurance
800-286-7445
www.Health-Insurance.com

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 agent@health-insurance.com .

Phil Lee
Lee Health Insurance Services
925-284-2000
www.health-insurance.com

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
plee@health-insurance.com
www.Health-Insurance.com

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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