It’s come to my attention that Kaiser Medicare Advantage HMO has raised its Annual Out of Pocket maximum to $6,700 starting on Jan. 1, 2018. This could be a financial burden for many seniors.
As an alternative, Medicare Supplement Plan F has $0 Out of Pocket costs for any Medicare-eligible medical expense (except for a separate Prescription Drug Plan), and allow access to any Medicare provider in the U.S.
For those turning 65 in Contra Costa, Anthem Blue Cross Medicare Supplement Plan F plan premiums can be as low as $115/month, after discounts. (This is compared to Kaiser Medicare Advantage’s monthly premium of $103/month, including Rx.)
If you have any questions, we’d be happy to consult with you on your options.
(The above is meant to be informational. This information has not been approved by CMS or any regulatory agency. This is not sales material and should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)
Phil Lee
Lee Health Insurance Services 925-284-2000
www.Health-Insurance.com
Employee Benefits & Health Insurance
(Note: This information concerns those who are on Individual & Family health plans. It does not concern you if you are on Medicare or an Employer or Employee on a Group-sponsored or Government-sponsored health plan. This information pertains only to California and does not apply to other states.)
This is a reminder that if you are currently on an Anthem Blue Cross Individual or Family (IFP) health plan (not Medicare or Group plan), and you received a notice from Anthem that your health plan will not be renewed on Jan. 1, then you need to take action by Dec. 15.
On Jan. 1, Anthem will be withdrawing IFP plans from all regions in California EXCEPT for 3. Those 3 regions and the affected counties are listed below. These include 22 sparsely populated counties in N. Calif., Santa Clara county and 5 counties in the Central Valley.
The IFP plans that are affected include plans within the Covered CA Exchange (On-Exchange), as well as plans outside the Covered CA Exchange (Off-Exchange). They include Subsidized plans as well as Non-Subsidized health plans. Those who are on Grandfathered IFP plans are not affected.
If you need help securing a plan from an alternate insurance carrier such as Blue Shield, Health Net or Kaiser, please contact me at [email protected] or call 925-284-2000 Ext. 101.
Anthem Blue Cross IFP Plans will be discontinued on Jan. 1 from all CA Counties EXCEPT the following:
Sincerely,
Phil Lee Lee Health Insurance Services
925-284-2000 Ext. 101
Employee Benefits & Health Insurance
]]>This is a reminder that we are in Open Enrollment season for several lines of health insurance plans.
(A) For Those Under Age 65 on Individual & Family Plans
• Annual Open Enrollment period (AEP) this year runs from Nov. 1 through Jan. 31.
• You may enroll into or change Covered CA On-Exchange (with subsidy) as well as Off-Exchange (no subsidy) plans.
• Competitive Rate Comparison Proposals for On Exchange as well as Off Exchange plans are now available for Jan. 1, 2018. Please let us know if you would like one prepared for you.
• On Jan. 1, Anthem Blue Cross will be terminating their Individual plans in most counties in California except for some in rural Northern California.
• If you received a cancellation notice from Anthem Blue Cross, please contact us for a proposal to show you alternative plans from Blue Shield, Health Net, Kaiser, etc.
• If you received a large rate increase, ask us for a proposal showing alternatives.
(B) For Those Seniors Over Age 65 on Medicare
• For those on Supplement plans, there is NO Open Enrollment Period. Your supplement plans do not require renewal and continue uninterrupted until you cancel it.
• For those on Supplement Plan F, CMS (Center for Medicare Medicaid Services) will prohibit new sales after Jan. 2020. But those who are already on Plan F at that time will be grandfathered indefinitely.
• For those wishing to switch from a Medicare Advantage HMO plan to a Supplement Plan, there is no Open Enrollment and no Guarantee-Issue (GI) unless you have a Qualifying Event (QE), such as a move from out of state. You will wish to review the 13 Guarantee-Issue (GI) situations in CA that you may possibly qualify for. Even if you don’t qualify, there is no penalty for applying and going through the non-GI underwriting (approval) process. Chances are good that you may still qualify based on your health. The process for this type of transition is tricky and the timing very tight. If you think you may want to do this, start this process early to give yourself enough time to receive approval. We recommend that you seek professional assistance from an experienced agent knowledgeable in this area.
(The above is meant to be informational. This information has not been approved by CMS or any regulatory agency. This is not sales material and should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)
Phil Lee
Lee Health Insurance Services 925-284-2000
www.linkedIn.com/in/philwlee
www.Health-Insurance.com
[email protected]
Employee Benefits & Health Insurance
I received the following email from Anthem to agents and brokers last week with details about this decision. Please click on the link below:
Please review the following to be sure that you will actually be affected by this:
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
]]>The Senate Appropriations committee’s own budget analyst has estimated the cost to be $400 billion for just the first year, which is over twice the entire California State budget of $180 billion. SB 562’s sponsors have no clear plan for paying for single payer but have suggested new employer and employee taxes and income tax increases. These taxes would be in addition to current Federal, State, local, municipal and property taxes that Californians pay.
Please see this press release from the California Association of Health Underwriters for more information.
https://bliscorp.egnyte.com/dl/6kk5OkKcvK
I was present in the Senate Chambers when this bill passed the Health Committee with a 5-2 party-line vote on April 26th. I was again present when the Appropriations Committee debated this bill on May 22nd. But despite serious concerns raised by many of the committee members the bill passed with a 5-2 party-line vote. It will now be voted on this week by the full Senate.
TO TAKE ACTION:
If you object to losing your right to Medicare, losing your employer plan, paying more taxes, losing your right to choose your doctor, your hospital and your insurance benefits please contact your State Senator to let him/her know. Click on the link below to find your State Senator and his/her contact information. Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/
For your convenience, this is a letter template suitable for sending to your district Senator if you so choose:
https://bliscorp.egnyte.com/dl/9IOEU956MF
Phil Lee
925-284-2000
]]>SB 562 is very bad for you, your family and the future of the State of California for many reasons:
CALL TO ACTION:
If you object to losing your right to Medicare, losing your employer plan, being taxed an additional $9,200 per family member, losing your right to choose your doctor, your hospital and your insurance benefits, then please contact your State Senator to let him/her know. Click on the link below to find your State Senator and his/her contact information. Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/
Just say No On SB 562 to preserve your choice in health care and to keep California from declining into certain economic ruin. Thank you for taking the time to read this email.
]]>As a courtesy, we are passing this information onto you.
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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)
925-284-2000
]]>I hope this will give you with some insight into the behind-the-scenes forces that are driving up health care costs.
How One Pharmaceutical Company Priced Its Drug
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
www.linkedin.com/in/philwlee www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable
Wall Street Journal 5/2/2016:
Valeant’s CEO Was Key Force on Pricing
Documents collected during a Senate investigation provide look at how Valeant arrived at sharp price increases
Michael Pearson, chief executive officer of Valeant, lobbied for aggressive price increases on acquired drugs in recent years. PHOTO: DREW ANGERER/BLOOMBERG NEWS
By JACQUIE MCNISH and LIZ HOFFMAN
Updated May 2, 2016 10:33 a.m. ET
In early 2015, when Valeant Pharmaceuticals International Inc.’s top brass met to set prices on a soon-to-be-acquired cardiac drug, some executives suggested slow, staggered price increases. Chief Executive Michael Pearson disagreed.
To reach Valeant’s internal profit targets, Mr. Pearson lobbied for a single, sharp increase. Hospitals could still make a profit at the higher price, he argued, which meant patients would still have access to the drug. The team deferred. The day it completed its February 2015 purchase of the drug, called Nitropress, Valeant tripled the cost.
The exchange, recounted in a document reviewed by The Wall Street Journal, shows in greater detail than was previously known how Valeant and its now-outgoing CEO Mr. Pearson pursued quick, aggressive price increases on acquired drugs in recent years—a strategy that sparked widespread backlash and landed Mr. Pearson in front of a Senate investigative panel last week.
A spokeswoman for Valeant, Laurie Little, said, “We heard very clearly the concerns raised by the Senate Special Committee on Aging, and the board is working to map out a new path for the company going forward. That will include consideration both of how best to set drug prices and of the appropriate role of patient assistance programs in helping to ensure that patients can obtain the drugs that doctors prescribe for them.”
At last week’s Senate committee hearing Mr. Pearson said Valeant was “too aggressive” with drug price increases.
Dozens of documents collected during the Senate investigation provide a deeper look at how Valeant arrived at sharp price hikes on some of the drugs it sells. The documents underscore the challenges Valeant faces now that it has promised to roll back some prices and rely less on acquisitions for which price increases are a major driver. That pivot has investors and analysts concerned about where Valeant’s profits will come from and how it will service the $30 billion in debt it carries.
Related Video
Valeant CEO Michael Pearson testified at a Senate hearing investigating drug pricing Wednesday that he and the company made mistakes and “Valeant was too aggressive.” Watch an excerpt of his testimony. Photo: AP
Concerns over the company’s reliance on price increases, its accounting and other business practices hammered Valeant stock, which has fallen more than 85% since its high last summer. Valeant has said it is comfortable with its liquidity.
William Ackman, a major Valeant shareholder and recently appointed director, told the Senate committee that he and other new directors have “stabilized” a company that has made “significant mistakes.” The company’s stock has gone up about 27% over the past month as the company filed a long-overdue annual report, hired a new CEO and reached an agreement with lenders to avoid a technical default.
Under Mr. Pearson, a former McKinsey & Co. consultant, Valeant earned a loyal following on Wall Street for its profitable strategy of buying existing drugs with price-increase potential rather than developing them in-house. “Bet on management, not on science,” he often said. While Valeant did have a research program, Mr. Pearson said that most of Valeant’s R&D products are reformulations of existing drugs, such as a new delivery method for a glaucoma medicine, according to the Senate documents.
Valeant’s pattern of price increases, including on Nitropress, was the subject of a page-one story by the Journal last year. That strategy drew criticism amid broader political scrutiny of pharmaceutical costs. The Senate panel last week—the third in a series of hearings on drug pricing—focused on four Valeant drugs in particular, including Nitropress and Isuprel, which Valeant acquired from Marathon Pharmaceuticals in February 2015.
The other two drugs, Cuprimine and Syprine, are used to treat Wilson’s disease, a rare ailment involving a buildup of copper in the body, and were acquired by Valeant in 2013. Months after it raised the price of the cardiac-care drugs in 2015, Valeant sharply raised its price tags on Cuprimine and Syprine.
The price of Cuprimine has risen 5,787% to $26,189 since 2013, with most of the increase occurring in the summer of 2015, according to an analysis prepared by Senate committee staff for the hearing. The cost of Syprine jumped 2,934% to $19,783 during the same period. A doctor testified at last week’s Senate hearing that a liver transplant, an alternative treatment for Wilson’s disease, is now cheaper than a lifetime of Valeant drugs.
The Senate analysis referred to wholesale acquisition costs that hospitals and other purchasers pay for drugs.
Although the four drugs made up only a fraction of Valeant’s $10.3 billion in 2015 sales, they ranked among Valeant’s 30 most profitable drugs as measured by net profit, Valeant Chief Financial Officer Robert Rosiello told the Senate committee last month in a written response to questions.
So valuable were Syprine and Cuprimine that when a senior Valeant official learned that Valeant’s customer-service group lacked a way to log inquiries from patients complaining about their rising costs, he wrote in an email that “for these…drugs we need to find a way asap.” He inquired about purchasing software to track their complaints. “These patients are too valuable to lose,” Laizer Kornwasser a former Valeant executive vice president, wrote, according to the Senate hearing documents.
Mr. Kornwasser didn’t immediately respond to requests for comment.
At the 2015 meeting on Nitropress, which was attended by Valeant’s then-finance chief,Howard Schiller, Mr. Kornwasser and other top executives, some of the executives recommended gradual price increases to avoid alienating core hospital buyers of the drug, the Senate documents show. Mr. Pearson argued it wasn’t an “exorbitant” price for a drug that saved lives and represented only a fraction of hospital costs, according to the documents.
Upon completing its purchase of the two drugs in February, Valeant sharply raised the price of both Isuprel and Nitropress.
A month later, when a Deloitte consultant studied further price-tag spikes on the two drugs, the consultant asked a senior Valeant executive in an email: “Are you ok with the above assumptions? They are leading to high gross margins (more than 99%).”
The Valeant executive replied in an email that the analysis “looks right, and I’m not surprised they are extremely profitable.”
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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:
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)
925-284-2000
www.linkedin.com/in/philwlee www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable
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