Group or Individual Plan After the Implementation of ACA 1/1/2014?

September 9, 2013 By

These are tough decisions for Consumers, Employees and Small Business Owners
1. Small Business Employers
Should Small Business Employers (<50 employees) Disband their Group plans, and allow employees to buy their own private Individual Health plans either inside Covered California (the State's Healthcare Exchange), or outside in the private marketplace? 2. Employees of Small or Large Businesses
Should Employees of Small Businesses enroll in their Employer’s Group Health plan, or try to apply for a subsidized plan from Covered California (the State’s Healthcare Exchange), or outside in the private marketplace?
Should Dependents (Spouses and children) of Employees who work for Small Businesses enroll them in their Employer’s Group Health plan, or try to apply for a subsidized plan from Covered California (the State’s Healthcare Exchange), or outside in the private marketplace?
3. Consumers who do not work for an Employer (Self Employed, Unemployed, Retired, etc.)
Should you continue your current plan, buy an Individual plan from the Exchange or buy one from the outside marketplace?

To help you in your decision-making, I have outlined some Pro’s and Con’s of Group plans vs. Individual plans.
Group Plans
Advantages
• Premiums tax-deductible to business
• Employee share of premiums tax deductible to employees.
• Possible Tax Credit available to Businesses with low income employees.
• A good health benefit plan makes an Employer more attractive when competing for competent employees.
• Employers may choose plans either within or outside of the Exchange. (To qualify for a tax credit, they are limited to just the Exchange plans.)

Disadvantages
• Employer’s time required to administer group plans.
• Employees cannot qualify for a tax subsidy if they are on an employer group plan.
• These plans are not portable for the employees if they terminate employment.

Individual Plans
Advantages
• Employees may apply for a tax subsidy if they are eligible.
• Employees may choose plans either from inside or outside of the Exchange.
• These plans are fully portable.
Disadvantages
• Premiums paid by the employees, are not tax deductible to the employees.
• If an employer reimburses the cost of individual premiums to employees, those contributions may not be deducted as a business expense.

Phil Lee
Phil Lee
www.Health-Insurance.com
www.HealthPlanTalk.com

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans Tagged With: , , , , , , , , , , , , , , , , ,

Implementation of ACA (Health Care Reform)

August 20, 2013 By

California Health Care Insurance Exchange Updates
Many developments have occurred since my last update. I will give a brief recap of the most important items that may impact your personal health care insurance situation.
Due to the large number of regulations and sheer volume of information related to health care reform. I will give you brief summaries of the most important items, in bullet point fashion. I have divided the items into 4 categories so that you only need to read the category that’s relevant to you.
You may choose to buy health plans either inside the California Exchange (Covered California) or outside. The only difference is that if you want either a subsidy or a tax credit, you have to choose an Exchange plan.

Your objective should be to:
1. Be insured.
2. Find the most affordable plan for your needs.
3. Qualify for a subsidy or tax credit, if you are eligible.

Individuals and Families
1. Major carriers participating in the Individual Exchange will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
2. The guarantee-issue rule for individual health plans will go forward as planned on Jan. 1st. Individuals and Families may enroll between Oct. 1st 2013 and March 1st 2014. Enrollment effective dates will be Jan. 1st or later.
3. Starting on Oct. 1st, Individuals and Families may start choosing and applying for Individuals health plans within Covered California (the State Individual Exchange) or from plans available outside the Exchange. Plan choices within the Exchange are likely to be more limited than plan offerings outside of the Exchange. However, if one needs a federal subsidy based on their income, they may only apply for plans within the Exchange.
4. Agents who are certified by the Exchange may offer health plans both inside and outside of the Exchange, and may assist consumers in applying for subsidies.
5. Federal and Cal Cobra will continue to be offered to terminated employees.

Small Groups (under 50 employees)
1. Major carriers participating in the Group Exchange, aka SHOP, will be Blue Shield, Health Net and Kaiser.
2. Tax credit will be available to employer groups with low salaried employees.
3. Most insurance carriers allow existing groups to renew early in Nov. or Dec. of 2013 so that they will not be subject to the new Jan. 1st ACA-compliant plans and rates for another 12 months.
4. 2 employee groups consisting of only the owner and spouse will no longer be allowed.
5. 1099 employees will not be considered employees for group eligibility.
6. Employer groups in CA must have 51% or more of its employees in CA in order to qualify. Out of State employees may enroll in an Individual/Family plan in their own state.
7. Agents who are certified by the Exchange may offer health plans both inside and outside of the Small Group Exchange, known as SHOP.
8. Flex Spending Account Salary Deferral limit of $2500 for 2014.
9. Employer Model Notices requirement – On Oct. 1st or within 14 days of hire.

Large Groups (50+ employees)
• The employer mandate to provide a minimum level of health insurance to employees, along with the associated penalties; have been delayed to Jan. 2015.

Medicare
• ACA and the Exchanges are not expected to affect Medicare.

For More Information:
Please go to the official website for the California Exchange, aka Covered California, at www.coveredca.com. You will find:
• Summaries of Exchange plans that will be available.
• Sample rates for Exchange plans for your age in your zip code.
• A calculator to help give you some idea if you might qualify for a subsidy.

Phil Lee
www.Health-Insurance.com
www.HealthPlanTalk.com

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans, Medicare Plans Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Will current Individual health insurance rates stay the same when Health Care Reform takes effect on Jan. 1st?

July 11, 2013 By

(The following information pertains to Individual and Family Health Insurance for those 64 years old or younger in California.)

Will current Individual health insurance rates stay the same when Health Care Reform takes effect on Jan. 1st?

We do not yet know what the rates will be. But rates are expected to be announced by the carriers in Sept. Those rates will take effect on Jan. 1st when the bulk of the ACA (Obamacare) rules take effect.
What we do know is that individual rates, which have traditionally been low in California, will rise to the level of the higher group rates. Young people will probably see their rates skyrocket. Those in older age groups will probably see more moderate increases.
The increases will likely be due to these factors:
1) The half dozen premium taxes, fees and other charges that will be levied to pay the expenses of the Federal program and the State-sponsored Exchanges.
2) The age band ratio changes from 1:9 to 1:3. Previously, the ratio could be as much as 1 to 9 of a younger person’s rate to that of the oldest age group. Under ACA, that ratio will be compressed to 1 to 3. This will drive up rates for young people while moderating those for the older groups.
3) Guarantee-Issue will result in higher rates. Previously the individual plan “pools” consisted of people who were generally healthy when they enrolled. With guarantee-issue, carriers will have to take all comers including those with significant pre-existing health conditions who previously could not qualify for these plans. This will drive up claims, and therefore premiums.
The carriers and the Exchanges will open for enrollment on Oct. 1st for plans to start on Jan. 1st. Plans will be offered both inside the State Exchanges and outside. The selection of plans within the Exchange will be more limited, but will allow you to apply for low income subsidies. Plans outside of the Exchange will have a much wider selection but will not be able to offer subsidies.
Premiums for similar plans will be the same, inside or outside of the Exchanges.

Phil Lee
www.HealthPlanTalk.com
www.Health-Insurance.com

Filed Under: Health Care Reform, Individual/Family Plans Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , ,

Health Care Reform Employer Mandate or “Play or Pay” Delayed until 2015

July 3, 2013 By
The White House announced yesterday that enforcement of the Health Care Reform mandate, aka Play or Pay, will be delayed until 2015. This mandate requires large employers with 50 or more full-time equivalent employees to offer minimum essential coverage to full-time employees (and dependents) or incur a penalty tax of between $2,000 and $3,000 per employee should any full-time employee obtain coverage through a “marketplace” with the assistance of a federal subsidy. The delay of this (large employer) Pay or Play mandate does not affect employees’ access to premium tax credits, nor does it affect any other provision such as the Individual mandate. This delay is intended to allow the Treasury Department (IRS) time to consider ways of simplifying the new reporting requirements consistent with the mandate and also time to adapt health coverage and reporting systems while employers are taking steps toward making health coverage affordable and accessible for their employees. Formal guidance describing this transition is expected within the next week. Following is a link to one of many articles reporting on this story: http://www.bizjournals.com/bizjournals/washingtonbureau/2013/07/02/health-care-reforms-employer-mandate.html
Filed Under: Group Plans, Health Care Reform Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Profit Margins for Health Care Companies

August 15, 2011 By

Net Profit Margins for players in the Health Care sector (first quarter 2011):
15.4% Drug Manufacturers – Major
13.9% Medical Instruments & Supplies
13.6% Drug Manufacturers – Other
12.7% Biotechnology
12.6% Medical Appliances & Equipment
9.0% Specialized Health Services
7.7% Drug Related Products
7.6% Diagnostic Substances
6.9% Home Health Care
6.3% Drugs – Generic
5.0% Hospitals
4.4% Health Care Plans
3.6% Medical Practitioners
1.8% Long Term Care Facilities
-2.3% Medical Labs & Research
-4.0% Drug Delivery

(Yahoo Finance 5/12/2011)
It’s clear from the above that despite rising costs and increasing premiums, Health Plans and Insurance Carriers are not earning huge profits from the health care industry. Price controls such as the MLR (Minimum Loss Ratio) in Health Care Reform which were directed at health insurance companies are unlikely to be effective at reducing costs.
What would be more effective at reducing cost would be to regulate the monopolistic pricing practices for the players at the top of the profitability heap, e.g. Brand Name drugs., patented medical devices. Other participants and cost factors that inflate health care, yet are not shown above include profits made by malpractice law firms. Overusage or use of unnecessarily costly procedures, especially among patients of cadillac care plans, such as those of public employee unions. Overusage due to the practice of defensive medicine. Continuous cost shifting by insolvent Government-run health care programs to the Private sector, e.g. Medicare, MediCal, Medicaid, Veterans programs. Government, by continuously lowering their reimbursement schedules to doctors and hospitals, below their profitability levels, are forcing them to charge higher fees to private payers like employers and families in order to remain in their medical practices. It explains the shortage of Family Practice Physicians because they receive the lowest reimbursement rates from these Government programs. Other cost drivers include fraudulent medical research papers, from unscrupulous researchers funded by cash-rich pharmaceutical companies, touting expensive new procedures and drugs.

www.health-insurance.com
www.healthplantalk.com

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans Tagged With: , , , , , , ,

Differences Between Individual and Group Health Insurance

June 22, 2009 By

For those individuals or family members who are not covered by an employer group health insurance plan, the individual health insurance market is the most popular first place to shop due to the attractive and affordable premiums. The monthly premiums for these plans are generally lower than what employers pay for group health plans, and therefore also lower than Cobra premiums. In addition there is a wide selection of plans with lower benefit levels (i.e. higher deductibles and fewer bells and whistles) and thus lower premiums for those with smaller budgets. The most important thing to know about the individual health insurance plan market is that you have to have good health to qualify. There is an application and underwriting process that determines your eligibility for these plans. There is generally no risk and no obligation in applying. Depending on your individual circumstances, the application process may take anywhere from a few minutes to several weeks. The application process and medical approval may involve the insurance underwriter having to obtain medical records from your physicians. The end result is that you may be either accepted, accepted at a higher rate level, postponed or declined for coverage.

Find Rates and Quotes for Affordable Health Insurance Plans at www.health-insurance.com.

© Philip W Lee, www.health-insurance.com, www.healthplantalk.com

Filed Under: Group Plans, Individual/Family Plans Tagged With: , , , , , , ,

Applying to the right California Health Insurance Plan

June 11, 2009 By

Depending on your health condition, you may not be accepted into some plans like individual and family health plans.
Since health plans and rates are vastly different between the individual/family health insurance market, the Small Group market, the Cobra and HIPAA markets. You need to determine which is the most advantageous plans to apply to first. Usually this would depend on which plans have the lowest rates. If in the event you do not qualify for your top plan choice, you need to determine which alternatives to explore and in what order.
Frequently this is dependent on certain deadlines. For example you may be given 45 days after your termination from an employer to decide if you want to accept the Cobra that you are offered. Or you may have a 63 day window to decide if you want to apply for a guarantee-issue HIPAA plan after your Cobra expires.
In addition, the cost of each of these alternatives will have to figure into your decision. If you are unable to figure out the best course of action on your own, you may need the assistance of an experienced health insurance agent to help you select the most appropriate plans to apply to in different markets and in different orders or priority, based on your personal health and medical care needs, your pre-existing conditions, your guarantee-issue options, your risk tolerance and your budget.

© Philip W Lee, www.health-insurance.com, www.healthplantalk.com

Filed Under: Individual/Family Plans Tagged With: , , , , , , , , , ,

How to Shop for Health Insurance in California

June 11, 2009 By

Start by determining what type of health insurance plan you currently have. Are you on:

• Your employer’s group health insurance plan?
• Your parents’ employer group health insurance plan?
• Your former or soon to be ex-spouse’s health plan?
• An individual health insurance plan?
• A Cobra or Cal-Cobra plan?
• A guarantee-issue HIPAA plan?
• A guarantee-issue high risk plan like California’s MRMIP (Major Risk Medical Insurance Program) or AIM (Access for Infoants and Mothers)?
• An employer group plan?
• A college-sponsored campus health insurance plan, with or without off campus coverage?
• A government-sponsored health insurance plan like Medicare, Medicaid, MediCal?
• A military health insurance plan like Tricare or medical coverage through the Veterans Administration?

If you don’t know the answer, you should start by asking your health insurance agent, your current health insurance carrier, your current or former employer, or your employer’s health insurance administrator, also known as a TPA (third party administrator).

In addition, if you don’t know already, find out what the premiums, costs and benefits of your current health plan are, i.e. the:

• Monthly Premium
• Office Visit Copay
• Annual Deductible
• Copays and deductibles for Brand Name and Generic drugs.
• Annual Maximum Out of Pocket Costs
• Maximum lifetime benefits
• Co-insurance percentage
• Hospital Copays or Coinsurance amounts
• Maximum daily or annual benefits if any.
• Maternity coverage if any
• Coverage for Preventive care such as annual Physical Exams, pap smear, mammogram, PSA antigen prostate test.
• Benefit limits not covered above

Once you know the details of your current plan, then you need to determine what your individual circumstances are:

• Are you terminating your employment from your employer?
• Is your former employer going out of business?
• Are you going to be offered Cobra?
• Are you in the election period of federal Cobra or Cal-Cobra?
• Are you being offered Cobra as a dependent spouse?
• Are you past the required Cobra Election period?
• Are you already on Cobra?
• Do you qualify for a guarantee-issue HIPAA plans?
• Do you have any pre-existing health conditions that would preclude you from being accepted into an individual or family health plan?
• Would your pre-existing condition be mild enough to allow you to still be accepted, but at a higher rate level?
• Do you own a small business with 2 or more full time employees including yourself?
• Does your profession have an association that offers guarantee-issue health plans?
• Are you in a low enough income bracket to allow you to qualify for coverage from certain government-sponsored health plans?
• Are you well covered by an employer, but are required to pay a substantial contribution from your paycheck in order to cover your spouse and your children?
• Are you turning 65 within the next 6 months?
• Are you between ages 18 and 23 and on your parents health insurance plan?
• Are you on your parents health insurance plan and about to leave college?

Next, you need to determine which health insurance “universe” or “market” you should be shopping in. The available markets are:

• Individual and family health insurance plan market
• Medicare senior health plans market
• Small business group health care plan market for companies with 2-50 employees.
• Mid market employer group health care plan market for companies with 51 to 200 employees
• Large employer group health care plan market for companies with over 200 employees.
• Association plans market for Individuals or small businesses in certain industries.
• Guarantee issue HIPAA plans market for those coming off of Cobra plans whose plans are ending.
• Government subsidized plans like Medical, Medicaid, Healthy Families, AIM, MRMIP (Major Risk Medical Insurance Plan)

Once you have gone through this exercise and know what type of health insurance plan you have now and what your options will be. Then it should be clear what steps to take next.

If it is still unclear to you what steps to take, then you should consult an experienced health insurance agent. Try to figure out with his/her assistance whether you should start applying to an individual health insurance plan first, or because of health conditions, not waste your time and go directly to a guarantee-issue plan, or try to set up a small group plan, etc., etc.
You may contact an agent at 800-286-7445. By email at [email protected], or go to www.health-insurance.com.

© Philip W Lee, www.health-insurance.com, www.healthplantalk.com

Filed Under: Individual/Family Plans Tagged With: , , , , , ,

Who should buy Individual and Family Health Insurance Plans

June 11, 2009 By

Health insurance plans are not always provided by employers. In the 60 or so years since World War II it has become customary for employers to provide workers with their health insurance plans. But this was not always the case. During the wage freeze of WWII, Employers were not allowed to raise wages to entice women to join the workforce. Their solution was to provide benefits, starting with health insurance coverage. This has since become an entitlement.

If you are:
1. 0 through 64 years old.
2. Currently uninsured.
3. If you are paying too much for your current health plan.
4. If you change jobs frequently and prefer to have an individual plan as a backup in case you are disabled.
5. If you are self-employed.
6. If you own a small business.
7. If your employer does not offer group health insurance.
8. If your employer offers to pay for an individual health plan on your behalf.
9. If you don’t like the choice of plan offered by your employer.
10. If you are on COBRA.
11. If you are on an expensive guarantee-issue HIPAA mandated health plan.
12. If you are on an expensive out of state health plan.
13. If you are on a health discount program that are frequently disguised as affordable health insurance. These plans are dangerous and are not true health insurance.
14. If you have been laid off or are in between jobs.
15. If you are forced to seek individual coverage due to a divorce.
16. If your employer’s plan does not offer you the providers you need.
17. If you missed your employer’s open enrollment period for coverage.
18. If you got dropped from your parents plan due to age (19 to 24) or lack of full time student status.
19. If you retired before age 65 and need to bridge coverage to age 65.
20. If it costs too much to cover your spouse and children under your employer’s plan.
21. If you just started your own business.
22. If you just immigrated to the U.S.
23. If you plan to travel to other states or countries for a part of the year.
24. If you are uninsured and don’t want to rely on government run county or state hospitals and clinics.
25. If you are a physician with your own medical practice.
26. If you are on a work visa in the U.S.
27. If you are visiting the U.S. for an extended period of time.
28. If you are a Foreign Student.
29. If your College or University does not offer any medical care outside of an on-campus clinic.

© Philip W Lee, www.health-insurance.com, www.healthplantalk.com

Filed Under: Individual/Family Plans Tagged With: , , , , , , , , , , ,
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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