Deadlines for INDIVIDUAL & FAMILY HEALTH PLANS (Either On-Exchange Covered CA plans or Off-Exchange plans)

(1) Deadline to enroll or change plans for a Jan. 1st effective date is Monday, Dec. 15th

(2) Open enrollment runs from 11/15/14 to 2/15/15. The deadlines corresponding to each effective date are:

Deadlines for each Effective Date

12/15/14 for 1/1/15

1/15/15 for 2/1/15

2/15/15 for 3/1/15

(3) If you are currently receiving a subsidy, then you must Renew by logging into Covered CA with your User ID and Password in order to re-certify to continue receiving the subsidy. (4) If you are uninsured, you may enroll by Dec. 15th to avoid a penalty in 2015.

Deadlines for EMPLOYERS WITH SMALL GROUP PLANS

(1) Groups on Grandfathered or Grandmothered plans will already have renewed on Dec. 1st.

(2) All groups, whether Grandfathered or Grandmothered will have a chance to change to new ACA plans with another insurance carrier on Jan. 1st.

(3) If you are dissolving an Employer Group plan and allowing employees to buy individual plans, they need to enroll by Dec. 15th for a Jan. 1st start. (Note that Individual health plans have significantly smaller Provider Networks than Group plans, and smaller Drug Formulary lists. Each of your employee will need to research their providers and formularies carefully before making a switch. Not all employees will qualify for subsidies. Employers are not allowed to use pre-tax dollars to pay for employees’ Individual plan premiums.)

Deadlines for SENIORS ON MEDICARE PLANS

(1) The deadline to change from a Medicare Advantage MA-PD plan (HMO or PPO) to another is Dec. 7th.

(2) The deadline to change from a Medicare Prescription Drug PDP Plan to another is Dec. 7th.

(3) For Medicare Supplement (or Medicare Gap) Plans there is no deadline and no renewal is necessary. These plans will continue as long as you continue paying the premium.

(4) For those of you who received termination notices from Scan Health and Health Net Medicare Advantage plans, you must enroll before Dec. 31st for a Jan. 1st effective date. Since some carriers will be closed during the holidays, you should submit these applications 2 weeks before Dec. 31.

(5) If you are on a Medicare Advantage MAPD plan and wish to switch to a Supplement plan and a PDP plan, you may do so, guarantee issue, only under 13 specific conditions. Otherwise, underwriting approval may be required and the timing of the switch can be tricky. The ideal time to make a change is between Oct. 15 and Dec. 7th, and as early as possible during this window. This should not be done without the assistance of a knowledgeable agent.

Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.

Phil Lee

www.health-insurance.com

http://www.yelp.com/biz/lee-insurance-services-lafayette-6

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:

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

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

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

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

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

IRS Overview:

http://www.irs.gov/newsroom/article/0,,id=223666,00.html

Frequently Asked Questions:

http://www.irs.gov/newsroom/article/0,,id=220839,00.html

In particular, the following 3 Simple Steps Chart helps you to determine if your company may qualify for these credits.

http://www.irs.gov/pub/irs-utl/3_simple_steps.pdf

For more information on Group Health Insurance, please go to www.health-insurance.com or call 800-286-7445.

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