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 Healthcare.gov 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 www.health-insurance.com, 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 www.Health-Insurance.com.

Phil Lee

Lee Health Insurance Services

www.health-insurance.com

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 CoveredCa.com 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 [email protected].

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
www.Health-Insurance.com
Blog: www.HealthPLanTalk.com

Covered California is not extending its deadline past March 31, 2014 for applying for a health plan

(This information pertains to Individual and Family health plans. Please ignore this email if you are on an Employer group plan, on Medicare or otherwise covered.)

Covered California is not extending its deadline past March 31, 2014 for applying for a health plan
Despite what you may have heard in the news about deadline extensions, these do not apply to California. There is no extension in California.
Based on our experience with past deadlines, Covered CA and possibly the insurance company websites may crash or be inaccessible on the last days. I highly urge you to apply before the end of Friday March 28th. If you miss the 3/31 deadline, you will have to wait until the end of the year to apply, and probably pay a penalty.
However, if you start an online application by 11:59 p.m. on March 31, 2014, you will have until 11:59 p.m. on April 15, 2014, to complete this application and to select a plan. To start an application, you must take at least the following steps:
• Create an online account.
• Fill out all required information on the “Apply for Benefits” page and click “Continue.” The page contains two required fields (see application screen images online at http://news.coveredca.com/p/blog-page_26.html).
• After clicking on “Continue,” you will be taken to the “Consent for Verification” page, where you need to click on “Save& Exit” or “Continue.”
• You must return to your online account no later than April 15 to complete the application and select a plan.
You also must make your first premium payment to the health insurance company by the due date in order to avoid the tax penalty.
How To Apply Online:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

Paper applications must be postmarked by March 31, 2014, to meet the open-enrollment deadline for 2014 Covered California plans.
Paper Covered CA Application: https://www.dropbox.com/s/olamsrnb43cv2xl/Fillable%20CovCA%20Application%20P%20Lee%20Agent.pdf
The mailing address for Covered CA is:
Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725
We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.

Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Tips on Applying to Covered California

Originally Posted on 3/25/2014
(This information relates only to Individual and Family health plans. Please ignore this email if you are on an Employer group plan, on Medicare or otherwise covered.)

Note: The last chance to apply for individual health insurance in 2014 is Monday March 31. However, based on our experience with past deadlines, Covered CA and possibly the insurance company websites may crash or be inaccessible on the last days. I highly urge you to apply before the end of Friday March 28th. If you miss the 3/31 deadline, you will have to wait until the end of the year to apply, and possibly pay a penalty.

Avoid these common mistakes on your Covered CA application:
• Designating an Agent — In order for us to help you during the enrollment process, and to troubleshoot problems, you must designate us as your agent on your online application. You do this by clicking “Finding Help Near You” on the upper right had corner of the screen. Please see screenshot instructions below:
https://www.dropbox.com/s/ckzl7m70h9brnt6/Agent%20Designation%20ScreenShots.docx
There is no cost to you to have an agent. And we provide free ongoing service and advice throughout the year.

• Remember your Username, Password and PIN — If you lose your login info, you will have to call Covered CA to reset them. Hold times may be as long as 3 hours, or not even be able to get through at all.

• Try to enter the correct information into the online application the first time around — some of the inputs are difficult to change unless you start a new application or call Covered CA (hold times may be as long as 3 hours.)

• Social Security Numbers — If you have already started an application with one (or one set of) Social Security Numbers, the system will not allow you to start a new application with any of those numbers.

• Withdrawing an application in order to restart a new one — it may take up to 2 weeks before you will be allowed to start a new one. By which time, you may be past the deadline.

• Entering the wrong income amounts into the online application — Before signing and submitting the application, be sure to check the income amounts carefully. If you submit an erroneous income amount, it may be difficult to change later without having to submit an Income Change, or withdrawing the application

• Household Members — Household members include dependents, but only those dependents who are claimed as dependents on your tax return. If they are adult children, or elderly parents who are not claimed as dependents on your tax return, they are not considered dependents.

• Household Income — You must include income from all household members who are considered part of your legal or tax household, even if they are not applying for coverage. You must carefully check the correct boxes or circles to indicate this on your online application.

• 3 Categories of Coverage Depending on Your Income — There are 3 categories. (1) If your HH income is below 138% of the Federal Poverty Line (FPL), (or for children, 250% of FPL), you will be automatically slotted into Medi-Cal (the CA version of the federal Medicaid or welfare program). As you know, very few providers accept Medi-Cal. (2) If your HH income is between 138% and 400% of FPL, then you are eligible to receive a subsidy (Advanced Premium Tax Credit) to help pay the monthly premium. Furthermore, if your income is between 138% and 250% of FPL, in addition to the subsidy, you will also be eligible to receive Govt. assistance for reduced Copays, Deductibles and Max. Out of Pocket costs. These plans go by names like Silver 77 or Silver 93. (3) The last category of Coverage is for those with HH income over 400% of FPL. For those in this category, there is no subsidy from the Govt. You may purchase any plan outside of the Covered CA Exchange. Although you may purchase these plans inside the CovCA Exchange as well, for full price, it is advisable to go outside the Exchange (using the links below) because: (a) You will not need to provide income, immigration, or other private information outside, (b) Your private data will not be shared with Govt. agencies like the IRS, Homeland Security, etc. and not submitted to Govt. databases for verification, (c) there are more plans and more carriers available outside than inside, (d) the online application process with the insurance carriers outside of the Exchange is faster, shorter and the websites function much more smoothly, (e) the prices are the same whether outside or inside the CovCA Exchange, it’s just that subsidies are not available outside.

Links to Apply to OFF Exchange (non-subsidized, non-CoveredCA) health plans:
Anthem Blue Cross: https://brokerportal.anthem.com/ehb/web/bkr/acc/agentconnect/PHILIPLEE_1
Blue Shield: https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi
Health Net: https://www.healthnet.com/portal/consumer/ca/getYourQuote.ndo?region=CA&a=10952
Kaiser: https://smu.kaiserpermanente.org/expressweb/ClearWorkspace.action?nextAction=/user/URLDecryptAction.action&refID=7o830apvbn8eyriuut5qmukks0hfomvhibykqt7emn1yam3vpqwgnp5t815gww

How to apply to Covered CA and Outside marketplace:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Obamacare Deadlines – March 15 and March 31

Originally Posted 3/7/2014
(This E-blast pertains to people buying individual and family plans only. Medicare plans and employer plans are not affected by this announcement.)

1. Obamacare Deadlines – March 15 and March 31

MARCH 15TH IS THE LAST DAY TO SIGN UP FOR AN INDIVIDUAL HEALTH PLAN WITH AN APRIL 1, 2014 EFFECTIVE DATE.

Saturday, March 15th is the deadline to sign up for an individual plan with an Effective Date of April 1, 2014. This deadline applies to Covered California subsidized plans AND non-subsidized plans purchased directly from an insurance company.

Our office will be closed on Saturday, March 15th. If you need help choosing and applying for a plan you MUST call us by March 14.

To apply to Covered California and designate us as your agent or to apply to a non-subsidized plan please follow the link below.

March 31, 2014 IS THE LAST DAY TO BUY HEALTH INSURANCE FOR 2014.

The Effective Date of insurance coverage will be May 1, 2014. This deadline applies to Covered California plans AND non-subsidized plans purchased directly from an insurance company.

If you do not have insurance as of May 1, 2014 you will be subject to a penalty (tax) of the greater of $95 or 1% of adjusted gross income. And you will have to wait until Nov. to apply for Jan. 2015.

Please call us if we may assist you in securing coverage for 2014.

How to apply to Covered CA and Outside marketplace:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Update of Obamacare Deadlines

Originally Posted 1/15/2014

(This information applies only to Individual and Family health plans. It does not apply to Employer Group plans or to Medicare plans.)

Covered California Payment Deadlines:
For those of you who applied for Individual/Family coverage with an Effective Date of Jan. 1st., either On Exchange (Covered CA), or Off Exchange (from the insurance carrier). Some of the deadlines for initial premium payments have been extended. Those deadlines are:
Blue Shield, Jan. 15th
Health Net, Jan. 15th
Anthem Blue Cross, Jan. 31st
Kaiser, Jan. 31st
Open Enrollment Period Continues
If 1) your plan was cancelled, or
2) you were mapped to a new plan by your insurance carrier, or
3) you opted for an extension to March, or
4) you are on a grandfathered plan, or
5) you are simply uninsured
You may still apply to a new or change insurance carriers before March 31st.
Open Enrollment Application Deadlines:
For Feb. 1st start dates, the deadline is Jan. 15th.
For March 1st start date, the deadline is Feb. 15th.
For April 1st start date, the deadline is March 15th.
For May 1st start date, the deadline is March 31st.
Last day of Open Enrollment for 2014 is March 31st.

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
www.HealthPlanTalk.com
925-284-2000

Applications to Covered CA On and Off Exchange Health Plans. Provider Search Update.

(The following information does not apply to you if you are on an employer group plan or on Medicare.)

There appears to be a great deal of confusion as to where to submit an application and the role of an agent.
Much of the confusion stem from the failure of the CoveredCA media advertising to mention that in addition to the Covered California Exchange, there is also a whole marketplace of health plans and insurance carriers available to consumers OUTSIDE of the Covered CA Exchange (Off-Exchange). The major difference is that you may only apply for a subsidy INSIDE the CoveredCA Exchange (On-Exchange). But if you don’t qualify or need a subsidy, you may apply outside where all the same plans are also available at the same rates, plus additional carriers and plan choices.

In addition, the Covered CA advertising also fails to mention that agents (Certified Insurance Agents) like myself are available to help consumers to quote, evaluate and apply to BOTH On and Off Exchange plans. And that there are no fees for our services. And no difference in premium. And that we offer free ongoing service.

(A) To apply to a plan INSIDE the Covered CA Exchange (On-Exchange):
You must go to www.coveredca.com to apply. Please designate me as your agent (look for “Find Help Near You”). Step by Step instructions for applying:
https://www.dropbox.com/s/9pas1gmsycqdrfx/Application%20Screenshots%20CovCA.docx

(B) To apply to a plan OUTSIDE the Exchange (Off-Exchange), please use the following links to apply:

Anthem Blue Cross (Deadline Dec. 23rd): https://brokerportal.anthem.com/ehb/web/bkr/acc/agentconnect/PHILIPLEE_1

Blue Shield (Deadline Dec. 15th):
https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi

Health Net (Deadline Dec. 15th):
https://www.healthnet.com/portal/consumer/ca/getYourQuote.ndo?region=CA&a=10952

Kaiser: (Deadline Dec. 15th):
https://smu.kaiserpermanente.org/expressweb/ClearWorkspace.action?nextAction=/user/URLDecryptAction.action&refID=7o830apvbn8eyriuut5qmukks0hfomvhibykqt7emn1yam3vpqwgnp5t815gww

Note: If you miss the Dec. 15th deadline, you may still apply for a non-subsidized health plan through Covered CA. The only difference is that you will need to provide income and immigration information (to be shared by several Government agencies) even though you are not requesting a tax subsidy.

Provider Search

Anthem Blue Cross revised Provider Search
Go to www.anthem.com/CA
RHS under “Useful Tools”, click Find a Doctor.
On LHS Choose Doctor or Hospital #1
#2 Type Name of Doctor or Hospital
#3 Enter radius in miles and zip code.
#4 Enter State and Plan Type or network.
1. Plan Network for Covered CA Exchange:
a. Pathway X HMO Individual via Exchange
b. Pathway X PPO Individual via Exchange
c. Pathway X EPO Individual via Exchange
2. Plan Network for Non-Exchange:
a. Pathway HMO Individual
b. Pathway PPO Individual
c. Pathway EPO Individual

Blue Shield of CA Provider Finder
https://www.blueshieldca.com/fap/app/search.html
(Be sure to “Select a Plan” first before you search.)

Health Net Provider Finder
https://www.healthnet.com/portal/provider/providerSearch.do?region=CA

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
www.HealthPlanTalk.com
925-284-2000

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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