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

October 28, 2013 By

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: , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Why you should not rush into a Covered California Exchange health insurance plan right now.

October 16, 2013 By

• The CoveredCA.com online enrollment is still hampered by glitches and delays.
• Most of the carriers are only offering “skinny” networks of slimmed down providers within the Exchange plans.
• The Covered CA website and the carrier websites have either not been able to do Provider searches, or have been giving wrong results.
• The carriers have not yet released rates and details for their Off-Exchange health plans. This means that you cannot right now get a complete picture of what all is available in the marketplace.
• There will be 3 categories of health plans available on Jan. 1st.: Covered CA Exchange plans, Off-Exchange Mirror (Standardized) plans, and Off-Exchange non-Standardized plan.

You will have time to make a proper decision once all the information is out.
• The open enrollment period extends to March 31.
• The deadline for the Jan. 1st enrollment is Dec. 15th.
How to decide whether to buy an On-Exchange plan or Off-Exchange plan:
• If you know that you qualify for a Subsidy (Premium Assistance), then you have to purchase an Exchange plan such as a Bronze plan in order to get the subsidy.
• If you know that you don’t qualify for a subsidy, then you should purchase an Off-Exchange plan or Off-Off-Exchange plan, without subsidy.
• To find out if you may qualify for a subsidy, go to www.coveredca.com.

What to do Next?
• Certified Insurance Agents are expected to have the ability to provide you with complete quotes for all plans in the marketplace (in and out of the Exchange) sometime in Nov.
• The health insurance carriers are expected to have the correct provider network list online by Nov.
• There is no cost to use Insurance Agents who are certified by Covered CA to provide this ongoing service to you.

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

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

Covered California Health Benefit Exchanges Open for Business

September 30, 2013 By

Today, Tuesday Oct. 1st, Covered California, the State Individual Exchange, and SHOP, the State’s Small Business Exchange, will open for business.
Although they will open for business, the Exchange plans and rates may or may not be available for comparison on Tuesday. We will have to wait and see. As of Monday, none of the carriers have released their rates online on the quote engines. Even if Covered CA does have rates on their website tomorrow, many of the carriers may not have their non-Exchange plans available. We may not be able to see a complete picture of the marketplace until all plans are released and available online through the quote engines.
Once all the rates are available, then your certified insurance agent will be able to help you by running comparison reports of all the available options. We will be able to provide one-stop shopping of all plans available in the marketplace, inside or outside of the Exchange.
Just to recap. The two Exchanges account for only one portion of the total marketplace. There will also be individual health plans and group health plans available outside of these 2 State exchanges. Carriers that offer standardized (or metallic level) health plans within the Exchanges, also have to offer these same identical plans outside of the exchanges, and at the same prices. However, outside, carriers may also offer a broader selection of plans, in addition to the metallic plans.
Consumers and businesses are free to choose health plans either within the exchanges, or outside. But if you want to apply for a tax credit or subsidy, either as an individual or as a business, then you have to apply for a plan within one of the exchanges.
Comparing Health Plans
One thing to remember when comparing standardized metallic plans across different insurance carriers and when compared against non-standardized plans. Since benefit levels and coverage are regulated and standardized, there will not be much difference when comparing metallic plans across carriers. However, insurance carriers are still allowed to vary premiums and provider networks. These two will be the two most important features to pay attention to when comparing carriers.

Decision Time For Small Employer Groups (50 or fewer employees)
If you have an existing Small Group Plan, the following are some possible options that you may need to decide:
• Do nothing. Allow your plan to renew at the regularly scheduled renewal date in 2014. At that time, all ACA regulations and prices will be imposed. (An exception would be grandfathered plans prior to 3/23/2010).
• Renew early on Dec. 1st. Take advantage of carriers’ promotional RAF’s. Lock in rates and plans for 12 months. Delay impact of most of ACA-imposed regulations.
• Use Dec. 1st Early Renewal to change plans and lock in rates for 12 months.
• Use Dec.1st carrier RAF promotions to change to a more favorable rate or plan at another carrier.
• Renew on Jan. 1st to change to an ACA-compliant plan, and accept new rules on probation and family ratings.
• Change to another carrier on Jan. 1st or later (even after you have early renewed on Dec. 1st).
• Ask your Tax Advisor to help you calculate if your company may qualify for a Tax Credit. If so, you may want to consider buying an Exchange and ACA-compliant plan on Jan. 1st.

These decisions are complicated. Circumstances vary and every company’s options are different. You should consult with a certified insurance agent before making a decision.
Decision Time For Individuals and Families
If you already have an existing individual health plan. You may have to decide on one of these possible options. The following example is based on someone on an Anthem Blue Cross plan:
5. Do nothing. Allow Anthem to map your current plan to a comparable 2014 ACA-compliant plan on Jan. 1st. You will still have the opportunity, until March 31, to change to any other plan, inside or outside the Exchange.
6. If you have a grandfathered plan (prior to March 23, 2010), you may keep your plan and remain unchanged, except for the rate.
7. Use Anthem’s calculator tools online to compare plans and decide whether to change plans or not, and if so, whether to move to an Exchange or Non-Exchange plan.
8. Use the Covered CA Exchange’s coveredca.com online subsidy calculator to estimate if you and your family may qualify for a subsidy. If so, you may want to consider applying for an Exchange plan for Jan. 1. (Please keep in mind that if you apply for a subsidy, you will be required to disclose financial, personal and tax return info, which will be verified by different Govt. entities.)

These decisions are complicated. Circumstances vary and every individual’s options are different. You should consult with a certified insurance agent before making a decision.

Tips
• Anthem will be providing online decision tools: www.healthcareform4you.com, www.changemycoverage.com.
• The Exchange’s Covered California website will provide calculator tools for estimating if you might be eligible for a subsidy. www.coveredca.com.
• Your certified insurance agent will have powerful online Quote Engine tools to help you compare all plans in the marketplace, both inside and outside the Covered CA Exchange.
• Please remember that everyone’s personal situation is different. What may be the right move for a friend or family member may not be the right move for you. You have to tailor the decision to your own circumstances.

Key dates to remember:
• 10/1/2013 — Carriers release their 2014 Rates and Plans, for plans inside as well as outside the Covered California Exchange.
• 1/1/2014 — Implementation of the ACA (or Obamacare). All plans sold with this effective date or later must be ACA-compliant.
• 10/1/2013 – 3/31/2014 — Open Enrollment Period for all Individual and Family plans.
• 3/31/2014 — Last effective date to enroll into an Individual/Family plan without a special qualifying event.
• 10/15/2014 – 12/6/2014 — Open Enrollment Period for 1/1/2015 plans.

Phil Lee
800-286-7445
www.Health-Insurance.com
www.HealthPlanTalk.com

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

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

September 24, 2013 By

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: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Should Small Group Employers Renew Their Group Health Plans Early — in Dec. 2013 — ahead of ACA?

September 9, 2013 By

NOTE: This article applies to Small Group Employers with 50 or fewer employees.

(Please note that some of the information presented here are subject to change. Many of the ACA (Affordable Care Act) regulations and California Exchange rules are still being decided, clarified or modified by the regulators, and the carriers.)

Most Small Group Insurance Carriers are offering their members the opportunity to renew early on Dec. 1st, 2013, ahead of ACA implementation. If they wish to do so, they must submit Early Renew forms by certain deadlines.

Basically, for groups with renewal months between Jan. and June 2014, carriers have been offering a lower than normal renewal rate increase. They are doing this for business retention purposes, so that groups will not leave them en masse.

Whether you renew or not, there will be an increase of between 2% to 3.8% on Jan. 1st which is a pass-through of fees and taxes mandated by ACA to pay for the expenses of setting up the Exchanges. This is over and above any other increase.

Following are some of the reasons why a group would want to renew early. You can lock in your current plan design and known rate increase until Dec. of 2014. Most carriers have not released their 2014 rates and increases yet. But the following are possible reasons for you to renew early in order to be protected against these adverse effects until Dec. 2014.

1) If your current RAF (Risk Adjustment Factor) is less than 1.10, your group may suffer under the new ACA rules. RAF’s will go away. All groups will be rated the same regardless of risk. Healthy groups with low RAF’s will see their rates go up.
2) New ACA-compliant rules may change plan designs that may cause plans to become more pricey.
3) With ACA-mandated community-rating, premium differences due to age, which were at a 1:9 ratio (of young vs. old), will be compressed to 1:3, which means that companies with a large proportion of young employees will see significant increases in premium.
4) Premiums for families with children will go up because they will be assessing premium for each dependent child within a family up to 3, as long as they are 18 or under. (Children over 18 will be counted as adults in pricing.)

If you renew early, in Dec. 2013, then these changes will be postponed until Dec. 2014.

Since circumstances for everyone differ, if you need help on your specific situation please call Phil Lee, Lee Insurance Services at 800-286-7445.

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

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

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: , , , , , , , , , , , , , , , , , , , , , , , , , , ,
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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