Anthem Blue Cross grandfathered members: Unique to some states including California is a qualifying event that protects those who are impacted by a rate increase to their grandfathered health plans. Grandfathered plans were those in place prior to when the ACA law took effect and didn’t have to comply with many of the ACA requirements. In California, Anthem Blue Cross will have an April 1, 2020 rate increase on their remaining grandfathered plans. Those effected by this increase will qualify for special enrollment and be allowed move to any ACA complaint plan if they wish with the enrollment period being the same as stated above. Contact us for more information about this special enrollment opportunity.

New Short Term Special Enrollment: California has just announced a new special enrollment opportunity for those who remain unaware of the new state subsidy and new state penalty. With the federal government removing the penalty for not carrying qualified insurance, California has installed their own penalty for those residents who do not carry compliant insurance in 2020. In addition, Covered California, the state’s public marketplace, has added new state subsidies that goes beyond what the Affordable Care Act’s financial assistance provides. Those “uninformed” of these new changes can take advantage of this special short term enrollment opportunity through April 30, 2020. Specifically, this allows the uninsured additional time to enroll in coverage (and avoid a penalty) and those currently insured in the private market who wish to enroll through Covered California to take advantage of new state subsidies. For more information and assistance about this enrollment opportunity, visit: https://www.coveredca.com/

Happy to answer your questions.

Phil Dougherty

1). California is implementing a new state subsidy program which is estimated to qualify 235,000 more Californians for assistance in paying insurance premiums who previously did not qualify. The income limits for the subsidy are higher than the federal ACA premium tax credit subsidy. Where the federal subsidy provided assistance to households with incomes under 400% of the federal poverty line, the state program will provide subsidies to households with incomes between 400% and 600% of the federal poverty level. Subsidies are only available to those who enroll through CoveredCalifornia, the state’s public marketplace. See income chart below. For more information about CoveredCA plans and subsidies visit www.coveredca.com, or call CoveredCA at 800-300-1506.

2). Along with a few other states, California is implementing its own individual tax penalty mandate. The previous penalty on the federal level was removed by law and no penalty applied in 2019. In 2020, permanent CA residents who can afford health insurance but choose not to purchase it, whether through CoveredCA or the private market place, may be subject to a tax penalty which they will see in their state tax filing. The penalty is 2.5 percent of household income or $696 per adult whichever is greater. The money raised will go towards funding the new state subsidy program. To learn more about the penalty and exemptions, visit: https://www.coveredca.com/individuals-and-families/getting-covered/penalty-and-exemptions/

To learn more about the California health insurance marketplace, visit our web page where you can also view an explanatory video: California Health Insurance. For private market insurance information and quotes, visit OnlyHealthInsurance .

Medicare and most domestic medical insurance policies offer little or no coverage when traveling abroad, so travel insurance fills a significant gap. With the frequency of travel increasing for all demographics, the market has responded in kind. Annual policies that cover each trip taken in a twelve month period are now available. And, with just two or more trips in a year, these policies are typically cheaper than buying policies on a trip by trip basis. “Multi-Trip” travel plans provide the medical insurance and evacuation benefits found on traditional travel insurance, and some carriers even include coverage for services resulting from a pre-existing condition. To learn more, give us a call or visit our web  page: www.onlyhealthinsurance.com/travel.html

Happy travels,

Phil Dougherty

If you experience a qualifying life event, you can take advantage of a special enrollment period (SEP) to make changes to your existing individual health plan or buy a new one. In most cases, you’ll have 60 days prior to the qualifying life event and 60 days after the event to enroll with the effective date being first of the month following your enrollment.

Here is more information about qualified life events and eligibility: Qualifying Life Events for special enrollment

It should be noted that an eligible life event does not in itself guarantee enrollment. Documentation showing proof of such an event is needed and requirements and deadlines do vary among the different insurance carriers.  Some are stricter than others. Some for example, may require two or more pieces of evidence to show proof of residency and/or prior insurance.

Special note to Anthem Blue Cross members of terminating plans: A qualifying life event includes an individual health insurance policy (including “grandfathered” and “non-grandfathered” health insurance plan) that has expired or will soon expire. Anthem Blue Cross of CA is terminating some of their Grandfathered contracts Feb. 28, 2018, and would qualify as a life event for policyholders to obtain a replacement ACA compliant policy through the private market or public exchange (CoveredCA).

Let me know if you have any questions.

Phil Dougherty

For those who leave an employer sponsored plan, move, get married, or have another qualified life event, there is a special enrollment opportunity to enroll in coverage.

Note: This open enrollment period is not for those in Medicare.

Let us know if you have any questions or need help finding coverage.

Thanks, Phil Dougherty

The 2108 requirements are:

HSA Contribution Limits

• Individual Contribution Limit: $3,450
• Family Contribution Limit: $6,900

HSA Deductible Amounts

• Individual Minimum Deductible: $1,350
• Family Minimum Deductible: $2,700

HSA Out-of-Pocket (OOP) Amounts

• Individual OOP Maximum: $6,650
• Family OOP Maximum: $13,300

Please note: an individual or family plan that meets the deductible and out-of-pocket requirements, doesn’t necessarily qualify one to open an HSA. A plan designated as High Deductible Health Plan (HDHP) will meet these and other requirements necessary for HSA participation. Make sure your plan has HDHP included in its name and/or summary of benefits.

HDHP plans are available through the ACA (CoveredCA and private market) from many carriers and typically are found in the Bronze level of plans, a lower premium category. With rising premiums, HDHP plans coupled with a HSA account, may provide a more balanced long term health insurance solution.

For more information about HSA’s and how they work, visit our web page: http://www.onlyhealthinsurance.com/health-savings-accounts.html

We do know that in California, Open Enrollment will start November 1, 2017 and run through January 31, 2018.  Open enrollment is the time when individuals can enroll in coverage for the first time or change plans for the 2018 plan year. If you enroll by December 15th, coverage can start January 1, 2018. (Enroll by Jan 15th for Feb 1 start date and by January 31 for March 1 start date).

Carriers have been preparing. Anthem Blue Cross announced last month that they will be leaving the market in most CA counties. Most other carriers have prepared two sets of rates for 2018, one for business as usual and the other if the White House follows through with threats to pull federal subsidies and allow for waivers. In both cases, there will be increases with the latter being greater. California, having one of the more successful state-run marketplaces (CoveredCA), is in a better position than most states. California’s active private market (that offers more plan options, a streamlined enrollment process but no subsidies), will offer two PPO plans in addition to multiple HMO’s  in most counties.

With the delay and uncertainty mentioned above we do not expect carriers to release approved rates before open enrollment begins. Quoting services like the one we use, are gearing up to have all rates and plan information verified and ready for comparisons and release November 1, 2018.

We of course will once again be helping clients and your referrals with their health insurance decisions this open enrollment season. Feel free to visit our web site for quotes and information. OnlyHealthInsurance

Phone appointments with me can also be scheduled using my online scheduler: Make Appointment with Phil

Thank you.

Phil Dougherty

This does NOT affect Medicare Supplements, Medicaid, employer based plans, and Grandfathered plans (plans in effect prior to 2010).

So why the exit? Too risky. The instability of the marketplace, the shrinking Individual market, and heavy regulatory environment makes pricing plans with any confidence impossible. They will leave it to others and wait for workable changes from Washington.

Phil Dougherty

The Better Care Reconciliation Act (BCRA), the ACA replacement bill put forth by Senate Republican leadership, is short the necessary votes to pass this month (June), so they will attempt to schedule a vote following the July 4th recess provided they can rally defiant Republicans to support the bill.

The BCRA bill mirrors a House bill in a number of ways, but there are several key differences also. Even if it passes the Senate, it must pass the House first before going to the President for signature. The House could pass it as is, or negotiate a new compromise bill.

Although the specific timing to complete this process is unclear, both Congress and the Administration continue to be focused on the repeal and replacement of the ACA.

For those concerned about immediate changes, the BCRA includes a transition period of several years before some provisions go into effect and others sunset. And not all ACA provisions are impacted by the BCRA bill.

In short, the BCRA would repeal the individual and employer mandate and penalties, end some Medicaid funding, repeal most ACA fees and taxes and maintain some protections for pre-existing conditions. For more details, read this recent Kaiser Foundation update:

Summary of BCRA

California State Reform Measures

Effective July 1, 2017,  bipartisan legislation will go into effect barring “balance billing” from non-participating providers when being treated in In-network facilities. This limits a patient’s cost-sharing responsibility for services rendered from out-of-network providers at an in-network facility, to the amount the patient would have paid to an in-network provider and counts the cost-sharing amount toward the individual’s deductible and out of pocket limit.

A good example of this, and one many of my clients have faced through the years, is when a patient uses an in-network hospital or clinic, and unbeknownst to them, are treated by an out-of-network provider (one who does not contract with the insurer), such as an emergency physician,  second surgeon, radiologist or anesthesiologist. This consumer protection bill is intend to protect health care consumers from these surprise bills. Some welcome legislation.

California Single Payer

The state’s Single Payer initiative will remain “in committee” until further notice. There is still plenty of passion and support for such a solution, but the bill lacks specifics on funding, delivery of care and cost controls. But, it did what many believe it was meant to do: start the discussion and build on the momentum. The goal now among its supporters is to get it on the ballot for November 2018.

More updates to come. Stay tuned.

Phil Dougherty

Senate Republicans continue work on ACA replacement

Time may be running out on Senate Obamacare talks

Ideas emerge as Senate debates health care

Trump Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty

Senators explore options for pre-existing conditions

The most interesting headline is what’s happening right here in CA:

Calif. single-payer health care bill would cost $400B, analysis finds

A current bill in the CA legislature (SB562) would remove insurance companies from healthcare delivery and provide 100% coverage for all legal and illegal residents (including Medicare recipients, Medi-Cal recipients, employer based insurance participants, enrollees in CoveredCA and private insurance plans). All public funds currently utilized on healthcare (Medicare, Medi-Cal, CoveredCA subsidies) would be used to cover half of the $400 billion estimate with the other 50% coming from employer and personal tax increases.

Gov. Jerry Brown has concerns and the bill would need Washington’s (Trump) approval in releasing federal funds to such a program. California loves to be first and you can bet other states will see how this progresses.

The longer it takes for an Obamacare “fix”,  the greater success single payer initiatives will have in gaining followers.

Stay Tuned.

Phil Dougherty