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Obamacare — What You Should Do Next with your Health Plan

November 14, 2013 By Phil Lee

(This information applies only to Individual & Family health plans. It does not pertain to Employer group plans, employee plans or Medicare plans.)

Today, everything has changed once again! In a press conference this morning, President Obama announced that he wants policy cancellations to be delayed for one year.

How and whether this will be implemented will be decided by the HHS (Dept. of Health & Human Services), the California Insurance Commissioner, Dave Jones, and each insurance company. The final information will trickle down to us after these decisions are made. We don’t know yet when that will be.

Our phone has been ringing non-stop since this announcement. I will give you what we know and suggest some next steps.

1. Before you make any move, please follow the instructions on the piece “Choose an On or Off Exchange plan” to figure out if: (a) you qualify for a subsidy, (b) if your providers are on the network of the 2014 plans and (c) if your prescription drugs are on the formulary lists of the 2014 plans.
2. If you are on a grandfathered plan, you do not need to change anything unless you want to. Your plan will continue as is with the same benefits, provider network, and formulary lists.
3. If you are on a plan where you have received a cancellation notice for Dec. 31. This may be delayed until Dec. 2014. We are waiting for information on this.
4. If you have received a notice that your plan will be “mapped” to a new plan Jan. 1st, this also may be delayed until Dec. 2014.
5. If you want to change plans on Dec. 1st, please contact us.
6. If you received a large rate increase and want to consider other carriers and plans on Dec. 1st or Jan. 1st, please contact us.
7. If you qualify for a subsidy and want a Covered CA plan, please contact us for advice, online enrollment instructions and a paper application.

Please contact me know if you would like me to receive the following attachments:
A. “Choose On or Off Exchange plan” helps you to choose a plan inside or outside the Exchange (with screenshots).
B. “Fillable CoveredCA application” is a fillable Covered CA paper application in pdf format.
C. “Application Screenshots CovCA” takes you step by step to start an application, set up a Profile and Designate an Agent with screenshots).
D. “Agent Designation Screenshots” shows you how to designate an Agent (with screenshots).

Phil Lee
www.health-insurance.com
www.healthplantalk.com
800-286-7445

ACA Obamacare and Covered California Health Plans – What to do now

October 28, 2013 By Phil Lee

ACA and Covered CA Health Plans
What should you do now?

(This info applies to Individuals and Families under the age of 65 who are not on Medicare)

As you have probably been reading in the media, the ACA rollout and the California version, Covered California, is a disaster right now. Their contractors are scrambling to try to fix the mess on the CoveredCA.com website. We have been advising all of our clients, even if they already know that they want to enroll into the subsidized Covered CA exchange, that they wait until late in Nov. The deadline to apply for a 1/1/14 effective date is 12/15/13. You still have time.

The main problems are: 1) No reliable source to confirm if one’s doctors are in the reduced limited provider networks, 2) No info yet (rates, benefits, networks and formulary lists) for the off-Exchange plans, 3) The Covered CA website is not fixed yet, 4) No way to check prescription drug formulary lists on the reduced or limited drug formularies within the Exchange plans.

There is a paper, and pdf file version of the Covered CA enrollment application form that is much more reliable than the glitchy coveredca.com website. Please contact Lee Insurance Services at 925-284-2000 for a copy. You may submit a completed form to them to process for you.

As part of their ongoing service, Lee Insurance will review, correct, submit, confirm, monitor, troubleshoot and provide ongoing support for all applications that you submit to them. There are no fees for the free service, they are paid a nominal ongoing commission by the insurance carrier to provide you with their excellent local support.

Philip W. Lee
800-286-7445
www.Health-Insurance.com
www.HealthPlanTalk.com

Filed Under: Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Insurance, children health insurance, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, HBEX, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Insurance Marketplace, Health Plans California, health subsidy calculator, Individual Health Insurance, Individual Health Plans, Individual Subsidy, Obamacare, Obamacare rollout, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA

What is the difference between Covered California On-Exchange, Off-Exchange and Off-Off-Exchange Health Insurance Plans?

October 22, 2013 By Phil Lee

What is the difference between Covered California On-Exchange, Off-Exchange and Off-Off-Exchange Health Plans?
1) On-Exchange plans are offered by the official Covered California Exchange to consumers and small businesses. They have the following characteristics:
• 4 Standardized Metallic Tiers of plans called: Platinum, Gold, Silver and Bronze.
• There also offer a Catastropic level plan to 18 to 30 year olds only.
• Each Metallic Level plan may be offered by several of the carriers in each county, e.g. Anthem Blue Cross, Blue Shield, Kaiser and Health Net.
• On-Exchange Plans may be purchased online, through a licensed and certified Agent or through a CEC (certified enrollment counselor).
• You may apply for a federal Subsidy (or Premium Assistance) at the time that you make you application for enrollment.
• Most On-Exchange plans have reduced or limited networks of providers.

There are 2 kinds of Off Exchange Plans:
2) Off Exchange plans that “mirror” the Metallic Level plans and are identical to them. These plans usually have different names than the metallic plans.• Rates are the same between the On Exchange plans and the Off Exchange “Mirror” plans.
• They offer the same 4 metallic level plans, although under different names.
• Subsidies are not offered on Off Exchange plans.
• Off-Exchange plans may have either full or limited provider networks.

3) Off-Off Exchange Plans that are not standardized and are different from any of the On Exchange or Off-Exchange “Mirror” plans.
• Rates and Benefits are different than On Exchange plans.
• No Subsidies are offered for these Off-Off Exchange plans.
• Off-Off Exchange plans are more likely to offer full provider networks in addition to limited provider network plans.

On Exchange plans (1) are identical to Off Exchange plans (2). The only difference is that one may apply for a subsidy if they purchase an On Exchange plan. No subsidy are available on Off Exchange plans. On the Individual Exchange, one may apply for an individual subsidy based on income. On the SHOP Exchange, small business employers may apply for a tax credit to help pay for premiums on employee plans.

With On Exchange plans, each metallic level may offer a choice of multiple carriers to their employees simultaneously, like Anthem and Kaiser, or Blue Shield and Kaiser. While Off Exchange plans may be purchased only from one carrier at a time.
Off-Off Exchange plans (3) may offer many plan designs not available under the 4 standardized metallic levels.
Off-Off Exchange plans are more likely to offer larger provider networks than On-Exchange plans.

Phil Lee
www.health-insurance.com
www.healthplantalk.com

Filed Under: Group Plans, Health Care Reform, Health Savings Accounts, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Exchange, California Health Insurance, Catastrophic Health Plan, Certified Enrollment Counselor, Certified Insurance Agent, children health insurance, Covered CA Exchange, Covered California, Covered California Exchange, Covered California Health Exchange, Family Health Insurance, Family Health Plans, Group Health Insurance, HBEX, Health Benefit Exchange, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, Health Exchange, health insurance, Health Insurance Agent, Health Insurance California, Health Insurance Marketplace, Health Plans California, health subsidy calculator, Heatlh Insurance Broker, Individual Health Insurance, Individual Mandate, Individual Subsidy, Insurance Broker, Kaiser, Licensed Insurance Agent, Obamacare, Off Exchange, Off Off Exchange, On Exchange, Patient Protection and Affordability Act, PPACA, tax subsidy

Health Care Reform (ACA) Implementation Jan. 1st, 2014 – California Updates

September 24, 2013 By Phil Lee

Latest Updates

Individuals and Families
• Insurance Carriers are expected to release their health plan offerings for 2014 on Oct. 1st.
• The major carriers offering Individual/Family plans in the Bay Area will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
• Individual & Family purchase mandates and penalties will go into effect on Jan. 1st. Large Employer Group (50+ Employees) mandates and penalties, however, have been postponed to 1/1/2015.

Small Employer Groups (50 or fewer employees)
• Model Notices — All Employers are required to give “Model Notices” to all their employees by Oct. 1st, and to new hires within 14 days of hire. This is a Dept. of Labor mandated notice, that talks about employees’ and dependents’ options, under ACA, to employer and individual health coverage, Exchanges, subsidies and tax credits.
• Previously, this Model Notice law carried a penalty to Employers of $1,000 per employee for non-compliance. Last week, the Dept. of Labor announced a waiver of the penalty for non-compliance. But they still want employers to send out those notices.
• Anthem Blue Cross will not be offering any Small Group health plans within the Covered California Exchange. But they will be offering a wide selection of non-standardized plans outside of the Exchange.

Large Employer Groups (50+ employees)
• Model Notices — Penalties waived, see above.

Medicare Individuals
If you are on Medicare, you are mostly unaffected by the implementation of ACA on Jan. 1st.

Phil Lee

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem, Anthem Blue Cross, Blue Cross, Blue Shield, Blue Shield of California, California Department of Insurance, California Exchange, California Health Exchange, California Health Insurance, children health insurance, Covered CA Health Exchange, Covered California, Covered California Health Exchange, CoveredCA, Employer Health Care Purchase mandate, Family Health Insurance, Family Health Plans, Group Health Insurance, Group Health Plans, HBEX, Health Benefit Exchange, Health Care Plans, Health Care Reform, Health care subsidy, Health Exchange Marketplaces, health insurance, Health Insurance California, Health Insurance Mandate Penalties, Health Insurance Marketplace, Health Net, Health Plans California, Individual & Family health plan mandates, Individual & Family Health Plans, Individual Health Plans, Individual Mandate, Individual Subsidy, Kaiser, Large Employer Groups, Medicare Plans, Model Notice Penalties, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA, Small Business Tax Credit, Small Employer Groups

Obamacare — What You Should Do Next with your Health Plan

ACA Obamacare and Covered California Health Plans – What to do now

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